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Biomedical subjects

E Fiori

Publications and source records attributed to E Fiori.

At least 19 recordsLinked to original sources
PubMed2005

Characterization of tumoral lesions of the breast: preliminary experience with multislice spiral CT.

The aim of the present study was to validate low dose Multislice Spiral Computed Tomography (MSCT) in the diagnosis of breast lesions. Fourteen patients with mammographic and ultrasound findings suspect of malignant neoplasm underwent dynamic MSCT of the breast under basal conditions and 1, 3, and 6 minutes after intravenous injection of iodinated contrast medium. Both enhancement of the lesion >100% without further increase after 6 minutes, and irregular margins of the lesion were considered signs of malignancy. All lesions were examined cytologically and/or histologically. A correct diagnosis was achieved by MSCT in 7/8 malignant lesions, and in 6/6 benign lesions. The only malignant lesion missed by MSCT was histologically a ductal carcinoma in situ (false negative). In one case the MSCT showed the multifocality of an infiltrating ductal carcinoma, and in another it defined the bilaterality of the malignant lesions. Sensitivity and specificity of MSCT in the diagnosis of malignancy of a lesion were 88% and 100%, respectively. Our results suggest that MSCT is an effective diagnostic method to define suspicious breast lesions, and a valid alternative to Magnetic Resonance Imaging, especially when the latter is not feasible.

Breast Neoplasms↗
PubMed2004

The role of Echo Colour/Power Doppler and magnetic resonance in expansive parotid lesions.

The purpose of this research was to evaluate the role of Echo Colour/Power Doppler and Magnetic Resonance Imaging (MRI) in the diagnosis of expansive parotid lesions, and to establish criteria for differential diagnosis between benign and malignant forms. Forty nine patients (23 males and 26 females), aging from 30 to 85 years, with an expansive pathology of parotid gland were enrolled in our study from February 1999 through August 2004. Each patient was carefully assessed employing both ultrasonography integrated with Color/Power Doppler and MRI. Eventually, all patients received echo-guided needle-biopsy and surgical excision of the parotid lesion. Preliminary ultrasound assessed site, size, echoic appearance and margins of the lesion. In order to assess blood supply by means of Colour/Power Doppler, we divided the patients in four groups. Our MRI diagnostic criteria included site, size, intensity of signal, behaviour of the lesion after i.v. contrast, relationship with facial nerve and retromandibular vein, detection of margins and proximity to adjacent structures. On the basis of our results, the Authors concluded that both Echo Colour/Power Doppler and MRI play a very important role in the diagnosis and surgical planning of parotid gland lesions.

Adenoma↗
PubMed2003

Subcutaneous metastasis of pancreatic cancer in the site of percutaneous biliary drainage.

A subcutaneous metastatic lesion from a carcinoma of the pancreas or common bile-duct along the tract of a percutaneous transhepatic biliary drainage is a rare finding. Prompted by a case that came to our observation by chance, we reviewed the literature and analysed the 29 cases collected. Neoplastic cell seeding along a percutaneous drainage tract, albeit rare, must be kept in mind. The complication can be avoided if patients at risk, whenever possible, undergo endoscopic drainage.

Aged↗
PubMed2003

[Unusual localizations of hydatid cyst. Epidemiological aspects and diagnostic problems. Description of a clinical case].

A rare case of primary hydatid cyst of the mesentery is described. Though cystic echinococcosis infestation can occur in any part of the body primary peritoneal involvement is rare. The mechanism of primitive peritoneal infection by the parasite is still unclear. The hypotheses which can explain this rare primary localization, the sensitivity and the specificity of the serological and instrumental tests and the therapeutic management of this atypical lesion are discussed.

Echinococcosis↗
PubMed2002

Unusual breakage of a plastic biliary endoprosthesis causing an enterocutaneous fistula.

OBJECTIVE: The objective of our study was to illustrate a case of endoscopically placed biliary stent breakage. METHODS: A72-year-old woman with a prolonged history of cholangitis following laparoscopic cholecistectomy was referred to our institution 8 years ago. Dilatation of the intra- and extrahepatic biliary tree and a benign stricture at the cystic confluence were observed at US and endoscopic retrograde cholangiopancreatography (ERCP). A 12-F gauge plastic endoprosthesis was placed. In the absence of any symptoms, breakage of the stent was revealed 18 months later at plain radiology. Eight years later an enterocutaneous fistula occurred originating from a jejunal loop containing the indwelled distal part of the stent. Surgery was undertaken and the distal part of the stent removed with the perforated jejunal loop. The proximal part was successively endoscopically removed. CONCLUSIONS: Disruption of a biliary endoprosthesis is observed in patients in whom the stent is kept in situ for a long period or consequent to exchange. The removal and exchange is mandatory when the stent disruption is followed by cholangitis. In the current case, because of the absence of any symptoms the removal of the stent was not attempted. Immediate endoscopic removal of the prosthetic fragments seems to be the treatment of choice for replacement of a new stent.

Aged↗
PubMed2002

Giant diverticulum of the sigmoid colon with perforation. Report of a case.

We present a case of perforated giant diverticulum of the sigmoid colon. This condition is extremely rare and only a few cases have so far been reported in the literature. Our case involved a 55-year old woman. Diagnosis was easy with barium enema and CT scan examination. Laparotomy revealed a giant diverticulum of the sigmoid colon compressing adjacent structures with signs of inflammation. An en bloc resection of the sigmoid colon, ovary and fallopian tube was performed with primary colon-rectal anastomosis. The post-operative course was uneventful.

Diverticulum, Colon↗
PubMed2002

[Retroperitoneal leiomyosarcoma: clinical case].

The Authors have reported a case of retroperitoneal leiomyosarcoma. The retroperitoneal localization is quite unusual and early diagnosis is difficult. Only surgery operation and radio-chemotherapy can improve the prognosis. Tumor size is the major prognostic factor.

Adult↗
PubMed2002

Prognostic significance of primary-tumor extension, stage and grade of nuclear differentiation in patients with renal cell carcinoma.

Surgery remains the preferred therapy for renal cell carcinoma. The various adjunctive or complementary therapies currently yield disappointing results. Identifying reliable prognostic factors could help in selecting patients most likely to benefit from postoperative adjuvant therapies. We reviewed the surgical records of 78 patients who had undergone radical nephrectomy with lymphadenectomy for renal cell carcinoma, matched for type of operation and histology. According to staging (TNM), 5.1% of the patients were classified as stage I, 51.3% as stage II, 29.5% as stage III and 14.5% as stage IV. Of the 78 patients 40 were T2N0 and 21 T3aN0. Tumor grading showed that 39.7% of the patients had well-differentiated tumors(G1), 41.1% moderately-differentiated (G2), and 19.2% poorly-differentiated tumors (G3). Overall actuarial survival at 5 and 10 years was 100% for stage 1; 91.3% at 5 years and 83.1% at 10 years for stage II; 45.5% and 34.1% for stage III; and 29.1% and nil for stage IV (stage II vs stage III p = 0.0001). Patients with tumors confined to the kidney (pT2N0) had better 5- and 10-year survival rates than patients with tumors infiltrating the perirenal fat (pT3aN0) (p = 0.000006). Survival differed according to nuclear grading (G1 vs G3 ; p = 0.000005; G2 vs G3; p = 0.0009). In conclusion our review identified tumor stage, primary-tumor extension, and the grade of nuclear differentiation as reliable prognostic factors in patients with renal cell carcinomas.

Adolescent↗
PubMed2001

[Biliary-intestinal bypass in the treatment of severe obesity: personal experience with 23 patients].

BACKGROUND: The aim of this study was to determine the efficacy and safety of biliary-intestinal bypass in severely obese subjects (Body Mass Index > 35). METHODS: From January to December 1999, 23 patients (8 men and 15 women, mean age 36.6 years: range 20-51) affected with primary morbid obesity (BMI >40: range 40.1-64.7), in whom different attempt using conservative medicine have proved non-resolutive, underwent biliary-intestinal bypass. After the operation all the patients have been followed- up for 12 months. RESULTS: The mean Body Mass Index was reduced to 36.9 (range 27.7-44.1) after 6 months and to 33 (range 24.9-40.1) after 12 months. Peri and postoperative mortality was zero. Excessive malabsorption was efficaciously controlled by adequate replacement therapy. Diarrhoea, common compliance of every operation inducin malabsorbition, was reduced to 2-3 evacuation a day after 2-3 months. CONCLUSIONS: On the basis of personal experience it is underlined that biliary-intestinal bypass, as surgical treatment of morbid obesity refractory to medical therapy, is today a safe and effective operation (up to 80% of excess body weight lose); the presence of biliary-intestinal anastomosis reduces the post-operative loss of bile acids, choleretic diarrhoea and electrolytic disorders.

Adult↗
PubMed2001

[Emergency treatment of bleeding esophageal varices].

BACKGROUND: The hemorrhage from breakup of the varix esophageal is a dramatic complication of the hypertension of the circle portal, numerous attempts have stayed performed for identify the patients that present taller risk of hemorrhage, to the purpose of to establish the preventive more proper measures to arrive before the first episode of hemorrhage. The treatment of the patient with high pressure portal stays still today extremely controversial, to concern the choice of the more opportune strategies, that for it as concerns the choice of the better moment for effect the single therapies. METHODS: We have taken 63 patients treatises in urgency for esophageal variceal bleeding in consideration, we of the initial group of the 63 patients have subjected endoscopic 34 patients, subjected elastic binding of the varix 20 patients, and to derivative interventions in urgency 9 patients. RESULTS: The results to distance after surgical treatment for it as concern the rise of encephalopatia it show a percentage of the 60% of patient and the actuarial survival to 5 ages is of the 33.3%. CONCLUSIONS: In conclusion seem us of power affirm that the role of the endoscopic of the esophageal varix is prominent in the management of massive acute esophageal bleeding.

Adult↗
PubMed2001

[Lipoma of the small intestine: a rare cause of intestinal invagination].

Lipomas are an uncommon cause of small-bowel obstruction. The symptoms are intermittent and nonspecific. The Authors report a case in which intussusception was diagnosed with echography and the obstruction was treated with resection. They conclude that lipomas must always be considered in the differential diagnosis of intrabdominal neoplasms and in intestinal obstructions.

Adult↗
PubMed2000

Management of benign biliary strictures: biliary enteric anastomosis vs endoscopic stenting.

HYPOTHESIS: Although advances in endoscopic procedures have provided alternative options for relieving biliary obstructions, the overall chance of cure for patients with benign biliary stricture is the same using surgical or endoscopic treatment. DESIGN: Case-control study. SETTING: Tertiary care university hospital. PATIENTS: Of 163 patients referred for treatment with diagnoses of benign strictures of the common bile duct between January 1, 1975, and July 1, 1998, we studied 42 patients with postcholecystectomy stricture and a follow-up longer than 60 months. Twenty of these patients were treated with endoscopic stenting and 22 with surgery (hepaticojejunostomy, choledochojejunostomy, or intrahepatic cholangiojejunostomy). MAIN OUTCOME MEASURES: Postoperative mortality and morbidity and long-term outcome. The rate of restenosis was also determined. RESULTS: Morbidity occurred more frequently in patients treated with endoscopic procedures than with surgical ones (9 vs 2; P = .34). Hospital mortality was 0%. Surgery achieved excellent or good long-term outcome in 17 of 22 patients. Endoscopic biliary stenting was successful in 16 of 20 patients. Overall, excellent or good outcomes were achieved in 34 patients (81%). CONCLUSION: The ability to achieve steady, long-term results confirms hepaticojejunostomy as the best procedure in the treatment of benign biliary strictures, even if endoscopic procedures are gaining a new role in the treatment of a greater number of patients.

Anastomosis, Surgical↗
PubMed2000

Role of agonist-dependent receptor internalization in the regulation of mu opioid receptors.

Organotypic cultures and ileal neuromuscular preparations were used to determine (i) whether endogenous release of opioids by electrical stimulation induces mu receptor endocytosis, and (ii) whether and under which conditions ligand-induced mu receptor endocytosis influences the responsiveness of neurons expressing native mu receptors. In longitudinal muscle-myenteric plexus preparations, electrical stimulation at 20 Hz induced a prominent endocytosis of mu receptors in enteric neurons, indicating endogenous release of opioids. A similar massive endocytosis was triggered by exogenous application of the mu receptor agonist, [D-Ala(2),MePhe(4), Gly-ol(5)] enkephalin, whereas exogenous application of morphine was ineffective. [D-Ala(2),MePhe(4),Gly-ol(5)] enkephalin and morphine induced a concentration-dependent inhibition of neurogenic cholinergic twitch contractions to electrical stimulation at 0.1 Hz. beta-Chlornaltrexamine shifted to the right the inhibitory curve of both agonists with a concentration-dependent reduction of the maximum agonist response, which is consistent with the existence of spare mu opioid receptors. Under these conditions, the induction of mu receptor endocytosis by exogenously applied [D-Ala(2), MePhe(4),Gly-ol(5)] enkephalin diminished the inhibitory effect of this agonist on twitch contractions and tritiated acetylcholine release. In contrast, there was no reduction of the inhibitory effect of morphine, which failed to induce mu receptor endocytosis, on neurogenic cholinergic response. These results provide the first evidence for the occurrence of mu receptor endocytosis in neurons by endogenously released opioids and show that agonist-dependent mu receptor endocytosis could serve as a mechanism to regulate mu opioid receptor responsiveness to ligand stimulation when the opioid receptor reserve is reduced.

Acetylcholine↗