Biomedical subjects
Publications and source records attributed to Carmine Di Stasi.
A premature infant with rupture of percutaneous central catheter and subsequent migration of the fragment in the right atrium was reported. Umbilical venous catheterization was safely used to remove the fragment.
A newborn infant presented with severe heart failure due to a large hepatic arteriovenous malformation (AVM). Umbilical artery (UA) access was safely used for immediate diagnosis and for embolization.
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BACKGROUND: The aim of this study was to compare contrast-enhanced gray-scale harmonic ultrasound with multiphasic spiral computed tomography in the assessment of treatment efficacy of non-surgically treated HCC. METHODS: We studied 56 HCCs treated by percutaneous ethanol injection (31 cases), radiofrequency ablation (three cases), trans-arterial chemoembolization (12 cases), and combined treatment (10 cases). The efficacy of therapies was blindly assessed by multiphasic computed tomography and gray-scale harmonic ultrasound with a second-generation contrast agent (sulfur hexafluoride). RESULTS: On computed tomography 30 tumors (53.6%) showed complete necrosis, while 26 lesions (45.4%) were still viable. On contrast-enhanced ultrasound examination 33/56 nodules (58.9%) had no contrast enhancement in the arterial phase, while 23/56 lesions (41.1%) were still vascularized. All the nodules assessed as completely necrotic on computed tomography did not show arterial enhancement on contrast-enhanced ultrasound and diagnostic agreement was found in 53/56 cases (94.6%) (P<0.001). Contrast-enhanced ultrasound demonstrated relative sensitivity and specificity of 87.0% and 98.4%. CONCLUSIONS: Contrast-enhanced harmonic ultrasound is promising in the efficacy evaluation of ablation treatments for HCC. Nodules vascularized in the arterial phase on contrast harmonic ultrasound should be considered still viable and addressed to additional treatment without further evaluation.
OBJECTIVE: To evaluate the impact of uterine artery embolization (UAE) for fibroids on ovarian reserve in women younger than 40 years. DESIGN: Prospective study. SETTING: University-based reproductive endocrinology unit. PATIENT(S): Twenty regularly cycling women aged 33-39 years undergoing UAE for fibroids. All had cycle day 3 FSH levels <10 mIU/mL. INTERVENTION(S): Measurements of serum FSH and E2 levels and of the total ovarian volume and antral follicle number by transvaginal ultrasonography on day 3 of the menstrual cycle preceding UAE and on day 3 of the cycles occurring in months 3, 6, and 12 after UAE. MAIN OUTCOME MEASURE(S): Preprocedural and postprocedural hormone levels, ovarian volumes, and antral follicle numbers. RESULT(S): There were no significant changes from baseline in the mean day 3 FSH and E2 levels, ovarian volume measurements, and antral follicle numbers measured at 3, 6, and 12 months after UAE. CONCLUSION(S): Although this study might be not sensitive enough to conclude that UAE for fibroids does not interfere with a woman's ovarian status, these data indicate that in this series of reproductive-aged women UAE did not have short- or mid-term effects on ovarian reserve as assessed by hormonal and sonographic parameters.
OBJECTIVE: To report a case of permanent amenorrhea associated with endometrial atrophy after uterine artery embolization for symptomatic uterine fibroids. DESIGN: Case report. SETTING: Gynecologic clinic of a university hospital. PATIENT(S): A 44-year-old woman with menorrhagia and anemia caused by multiple fibroids. INTERVENTION(S): Transcatheter bilateral uterine artery embolization with polyvinyl alcohol particles, with hormonal, sonographic, and hysteroscopic follow-up procedures. MAIN OUTCOME MEASURE(S): Serum follicle-stimulating hormone (FSH) and estradiol levels were measured, and sonographic appearance of the ovaries and the endometrium at baseline and 1, 3, 6, and 12 months after treatment were recorded. Hysteroscopy was performed with endometrial biopsy at baseline and 6 months after embolization. RESULT(S): The patient remained amenorrheic from the procedure. Serial posttreatment measurements of FSH and estradiol levels and repeated ovarian imaging showed no change in ovarian function as compared with baseline. A reduction in endometrial thickness (<or=5 mm), as compared with the endometrial thickness measured at baseline (7.2 mm), was sonographically documented 1, 3, 6, and 12 months after treatment. Postprocedure hysteroscopy showed an atrophic endometrium, and endometrial biopsy confirmed endometrial atrophy. CONCLUSION(S): Permanent amenorrhea associated with endometrial atrophy may occur following uterine artery embolization for fibroids and, to the best of our knowledge, this is the first time this complication has been reported. Patients should be appropriately counseled about the risk of reduced fertility after embolization.
Hepatic artery stenosis and thrombosis represent dangerous complications of liver transplantation because the associated mortality and morbidity rates are high. In the past, repeat transplantation was considered the first-choice therapy; however, new surgical and interventional revascularization techniques have been suggested recently. Although extensive experience has been acquired with percutaneous transluminal angioplasty (PTA) and fibrinolysis techniques, only sporadic cases of stent placement in the hepatic artery of a transplanted liver have been reported, and no long-term results of this technique are available. In this study, seven stents (five Wallstents and two Palmaz stents) were positioned in four patients (two with stenoses and two with thromboses). Stent placement was performed in three cases after PTA and fibrinolysis, whereas primary stent placement was performed in the fourth. In all cases, technical success was achieved. During 18-25 months of follow-up, all stents proved patent and no patient required another transplantation. Although experience is still limited, the authors' experience indicates that placement of a stent in the hepatic artery in cases of stenosis or thrombosis yields good medium-term success, improving the results obtained by fibrinolysis and PTA and consequently enabling the graft to survive and avoiding the need for repeat transplantation.
BACKGROUND: True venous aneurysms of the renal veins are very uncommon lesions. Diagnosis is incidental, and thrombosed aneurysms may simulate solid renal masses. METHODS AND RESULTS: A case of right renal vein aneurysm incidentally found in a patient with a ispilateral renal carcinoma and abdominal aortic aneurysm is reported. While CT examination suggested a high-flow arteriovenous (A-V) malformation, a selective angiographic study identified two separate and independent pathologic conditions (venous aneurysm and intratumoral, acquired A-V fistulae). Successful preoperative embolization of the renal tumor was obtained and surgical treatment (nephrectomy+aneurysmectomy) was uneventful. CONCLUSIONS: Although uncommon, venous renal aneurysms require an accurate preoperative diagnosis; this case is interesting because the coexistence of renal tumor with acquired A-V fistulae raised the prospect of a large, high-flow A-V communication with secondary venous enlargement. The integrated imaging studies were basic to differentiate acquired, tumor-induced A-V fistulae found in the lower renal pole from the true venous aneurysm located in the upper pole. To our knowledge, this is the first report of such a condition.
Chronic venous insufficiency (CVI) is a pathologic condition caused by valvular incompetence, with or without associated venous outflow obstruction, which may affect both the superficial and the deep venous system, causing venous hypertension and stasis. The most common form of CVI is primary varicose veins due to the insufficiency of the saphenous system. Color-Doppler sonography (CDS) is actually the main diagnostic technique of imaging for CVI. In this article, we describe the anatomy, the technique, and the information necessary to the radiologist to perform CDS in chronic venous insufficiency. The knowledge of the venous anatomy is the cornerstone for an adequate sonographic examination. The venous network in the lower extremities is divided into three systems: superficial, deep, and perforating veins. Deep veins are "comitantes" to the corresponding arteries and run under the muscular fascia. Superficial veins course into the subcutaneous fat, superficially to the deep muscular fascia; the main superficial veins are the greater and lesser saphenous and their tributaries. Connection between the saphenous veins are defined as communicating veins. Superficial and deep veins are connected by perforating veins, with flow directed, under normal circumstances, from the superficial to the deep system. The main perforating are the Hunter in the mid thigh, the Dodd in the lower thigh, the Boyd in the upper calf, and the Cockett's in the middle and lower calf. Sonographic examination must be performed in the upright and supine position. Compression sonography and color and PW Doppler are systematically employed to assess the absence of deep venous thrombosis. Femoro-popliteal veins are evaluated with color and PW Doppler for valvular insufficiency with reflux by performing Valsalva maneuver and calf compression. The sapheno-femoral and sapheno-popliteal junctions are examined to identify type of junction, continence, accessory saphenous, and incompetent collaterals. Perforating veins are usually identified at the medial aspect of the thigh and at the medial, lateral, and posterior aspects of the leg. Outward flow (lasting more than 500 ms) in the perforating veins should be considered a sign of their incompetence. Several surgical and interventional procedures are now available for the treatment of the CVI, as follows: vein ligation and stripping, stab avulsion, endoluminal occlusion of the saphenous trunks, subfascial endoscopic perforator surgery, and valvuloplasty.
A case of a 37-year-old, 8 week pregnant woman come to the emergency service with the diagnosis of cervical pregnancy an metrorrhagia, is reported. Uterine artery embolization was performed to arrest the bleeding. BCF monitoring documented its disappearance after approximately 15 days with progressive decrease in serum beta-hCG levels. Once the death of the fetus was ascertained, placental detachment was facilitated with the administration of methotrexate therapy. In view of the curettage of the uterine cavity a second uterine artery embolization was performed. Twenty days after the diagnosis of abortion, curettage was performed and the patient could be discharged. The combined action of embolization, methotrexate therapy and curettage allowed to preserve the potential fertility of the woman.
The justification of a request of ERCP in a patient with hematobilia, was evaluated, based on the medical history and negative endoscopy findings for gastrocolic bleeding. The diagnostic examination was performed: it confirmed the release of blood from the papilla of Vater, however the definitive diagnosis could not be established; CT, as the examination of first choice was performed. It provided additional information and the diagnosis of aneurysm of the splenic vein apparently non communicating with the main pancreatic duct, was established. Angiography of the splenic artery was performed as the examination of second choice to definitely ascertain the source of bleeding. During the examination, the aneurysm embolization excluded the affected vessel from the circulation and allowed immediate benefit to the patient.
This study is a retrospective analysis of the impact of intravascular ultrasound in addiction to conventional angiography in 36 patients with 55 stenotic peripheral arterial lesions treated with angioplasty and/or stenting. Before treatment, intravascular ultrasound imaging showed that the vessel diameter was underestimated with angiography in 6 cases. The correlation index between angiography and intravascular ultrasound measurements, however, was significant in 27 arterial lesions. After endovascular treatment, angiography showed 3 vessel dissections and no incomplete stent deployment, whereas intravascular ultrasound showed 15 dissections and 5 instances of stent underdeployment. If we consider the intravascular ultrasound data as the gold standard, the specificity of angiography is 100%, while its sensitivity is 56% for vessel dissection and 75% for stent deployment. In the follow up of the 16 patients treated for iliac lesions with intravascular ultrasound control, re-stenosis occurred in 5% (primary patency 94.7%); in a control group of 15 patients treated in the same period without intravascular ultrasound control, re-stenosis occurred in 15.8% (primary patency 83.4%, difference not statistically significant). In conclusion, in the peripheral arteries intravascular ultrasound is more accurate than arteriography in evaluating dissection and stent deployment, but the routine use of intravascular ultrasound in every case of iliac PTA or stenting would not appear justified.