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E Iannicelli

Publications and source records attributed to E Iannicelli.

At least 19 recordsLinked to original sources
PubMed2005

Long-term clinical outcome of somatostatin analogues for treatment of progressive, metastatic, well-differentiated entero-pancreatic endocrine carcinoma.

BACKGROUND: Knowledge of factors able to predict the clinical outcome of homogenous series of entero-pancreatic endocrine tumours treated with somatostatin analogues is poor. This study was aimed at identifying predictors for efficacy of somatostatin analogues at inhibiting tumour growth and modifying patients' survival during long-term follow-up. PATIENTS AND METHODS: 31 patients with entero-pancreatic well-differentiated endocrine carcinoma received long-acting somatostatin analogues. All had progressive, metastatic disease (87% liver metastases, 38.7% distant extra-hepatic metastases). RESULTS: Response rate after 6 months of treatment was 45.2% (all disease stabilisation: 27.8% of pancreatic vs. 81.8% of intestinal tumours, P = 0.007). The predictors for non-response were: pancreatic tumour (OR 5.8), no previous surgery (OR 6.7), and the presence of distant extra-hepatic metastases, the latter being also confirmed by multivariate analysis (OR 10.0). Responders maintained stabilisation for 26.5 months, and none died during follow-up. Different survival curves were observed for patients, responding at 6 months compared to non-responders (P = 0.004), 3-year survival rate being 100% and 52.3%, respectively. CONCLUSIONS: Distant extra-hepatic metastases are the major predictor of poor efficacy of somatostatin analogues in progressive, metastatic, well-differentiated entero-pancreatic endocrine carcinomas. Patients achieving response after 6 months of treatment, maintain it throughout a long-term follow-up. Non-responders after 6 months of treatment, have a worse survival, and should be considered for alternative treatments.

Adult↗
PubMed2002

Integrated imaging in peripheral nerve lesions in type 1 neurofibromatosis.

PURPOSE: Our aim was to evaluate the role of Ultrasonography (US) and Magnetic Resonance (MR) in the staging and follow-up of peripheral nerve lesions in type 1 Neurofibromatosis (NF1). MATERIAL AND METHODS: We evaluated forty-six NF1 patients (16 males and 30 females, age range 12-65 years, mean age 34 years) affected by 51 soft tissue lesions, clinically diagnosed as subcutaneous (18 cases) and plexiform (33 cases) neurofibromas. The lesions were studied to identify site, size, extension, relationship with surrounding structures, and any features indicating malignant transformation. All patients underwent at least one US examination performed with a 7.5 - 10 MHz linear multi-frequency probe. All subcutaneous neurofibromas larger than 2 cm, all superficial or deep plexiform neurofibromas not clearly defined at US, and all large plexiform neurofibromas with massive involvement of surrounding tissues were studied by MR using 0.2 T magnet (Artoscan) or 1.5 T magnet (Magnetom Vision Plus Siemens). Fifteen patients underwent surgery; the remaining cases (31) were followed up according to the National Institutes of Health (NIH) protocol. RESULTS: The subcutaneous neurofibromas smaller than 2 cm showed homogeneous hypoechoic echotexture (10 cases), whereas lesions equal to or larger than 2 cm showed a characteristic target pattern (peripheral hypoechoic rim with hyperechoic core). All lesions larger than 2 cm studied by MRI displayed the target pattern in T2-weighted sequences, with peripheral signal hyperintensity and central signal hypointensity. At US, the 33 plexiform neurofibromas had an irregular shape with undefined borders; the patterns were classified as follows: 1) superficial plate-like lesions (14 cases); 2) superficial lesions with deep digitations (8 cases); 3) deep multi-lobulated lesions (5 cases); 4) extensive lesions massively involving soft tissues (6 cases). MRI was performed in 11 cases, showing an isointense or moderately hyperintense signal on T1-weighted sequences, high signal intensity on T2-weighted sequences, and, after intravenous gadolinium administration, variable enhancement on T1-weighted sequences. CONCLUSIONS: The results obtained in subcutaneous neurofibromas indicate a clear relationship between lesion size and US-MR imaging, with similar local staging. Since MRI failed to provide additional information, US may be considered the first-choice, and sometimes decisive, examination in these cases. As regards plexiform neurofibromas, US only proved useful in staging superficial lesions and partly deep multi-lobulated lesions as it accurately depicted lesion size, but not local extension; MRI is therefore useful in the preoperative staging of lesions. In extensive lesions, US proved unable to provide accurate and complete local staging of the lesions, so that MRI should be systematically used in these cases.

Adolescent↗
PubMed2001

Integrated diagnostic imaging of primary thoracic rhabdomyosarcoma.

We report a rare case of primary thoracic rhabdomyosarcoma in a girl who was referred with acute chest pain, hacking cough, and wheezing. A chest X-ray revealed a complete opacity of the right hemithorax. Ultrasound revealed a right-sided pleural effusion and a solid mass above the liver dome, suggesting a neoplastic disease, which quickly led to further specific examination. Use of CT and MRI together with bone scintigraphy completed the investigation. The biopsy specimen showed a pattern of alveolar rhabdomyosarcoma. This case was reported to emphasize the role of US in the evaluation of a child with hemithorax opacity.

Chest Pain↗
PubMed2001

Chronic granulomatous disease with gastric antral narrowing: a study and follow-up by MRI.

We report the case of a boy with chronic septic granulomatosis (CSG) who presented with a marked gastric antrum narrowing which was evaluated by MRI after oral intake of magnetic contrast particles, and after gadolinium i.v. administration. In particular, a mammillated aspect of the gastric wall in the antral region was seen. Follow-up by MRI clearly showed the gradual resolution of hyperemic wall thickness, after medical management. The antral stenosis resolved after 3 months. Magnetic resonance imaging provides detailed evaluation of gastric wall inflammation in course of CSG.

Child↗
PubMed2001

[Role of color Doppler US in the evaluation of renal transplant].

AIM: To assess the role of Ultrasound (US), US Color Doppler (CD) and Power Doppler (PD) in the diagnosis and in the follow-up of renal graft pathology by evaluating morphological and functional features of the vasculature and comparing these to other clinical parameters. MATERIAL AND METHODS: From January 1990 to June 2000, four hundred and thirty-six renal allograft recipients (mean age 45 years) underwent periodical US, CD and PD (mean follow-up 48 months) to evaluate morphology and perfusion of the graft. Resistive index (RI) and pulsatility index (PI) were measured in order to monitor flow variations from the renal to the arcuate arteries. PD was used mainly to study the morphology of the cortical vessels. The examinations were performed on an Esaote Biomedica AU-4/5 (Genoa, Italy) using a convex 3.5 MHz probe and a linear 7.5 MHz probe. On the basis of clinical data the patients were divided into 3 groups: A) Normal, B) Acute graft dysfunction, C) Chronic allograft nephropathy. In 87 patients (20%) percutaneous biopsy or FNAB was performed. RI and PI mean values +/-SD were calculated and compared to the other diagnostic parameters considered: serum creatinine level, US morphology, CD and PD vascularization. Finally RI and PI for each group were compared using the t -test in order to determine the statistical significance of the correlation between these indices and the patients clinical conditions. RESULTS: The 436 patients were divided as follows: Group A) 170 patients (39%); Group B) 105 patients (24%); Group C) 161 patients (37%). Urological and surgical complications were ruled out in all patients. RI and PI showed a similar trend exceeding cut-off values in Group B) and C) with highest peaks in Group B. Statistical analysis demonstrated the efficacy of this method in the differentiation between normal and pathological grafts, but there was a reduced statistical difference between the two pathological groups. Histological analysis performed on 87 patients (20%) showed good correlation with RI. DISCUSSION AND CONCLUSIONS: CD is a non-invasive diagnostic method which provides flow-metric quantitative parameters for the hemodynamic assessment of the renal transplant. These values present a certain sensitivity but are not specific of renal graft dysfunction, as there is no reliable differentiation between acute rejection and other parenchymal pathologies. During the follow-up, RI and PI have no predictive value. RI variations from renal artery to cortical vessels (hylum-cortical ratio) show a good correlation with the clinical evolution of the transplant. The evaluation of RI and PI can generally be limited to renal and interlobar arteries as arcuate sampling is necessary only when the hylum-cortical ratio shows reduction or inversion. Integration of clinical and instrumental diagnoses can reduce the number of biopsies.

Acute Disease↗
PubMed2001

[Bifid median nerve in the carpal tunnel: integrated imaging].

PURPOSE: Carpal Tunnel Syndrome (CTS) is a neuropathy caused by compression of the median nerve at the level of the wrist, which is caused by different pathologic conditions. In some cases it has been associated with anatomic variations of the median nerve, mainly with the early duplication of the nerve inside the carpal tunnel (III Group of Lanz). The treatment of CTS is mainly surgical consisting in decompression by transection of the transverse carpal ligament, which is better performed by endoscopic release. The aim of our study was to evaluate the possibility to detect this anatomic variant by integrated imaging and assess the value of this information for planning treatment. MATERIAL AND METHODS: We report 6 cases of bifid median nerve examined by Ultrasonography (US) using mechanic sectorial and linear array transducers operating at 10 to 13 MHz, and by MR imaging using 0.2 T equipment. RESULTS: In all cases US transverse scans showed two adjacent oval formations with a structure similar to that of the median nerve. CONCLUSIONS. MR imaging confirmed the sonographic findings in all cases. All patients underwent open surgical treatment by decompression of the median nerve; in all cases an early duplicated median nerve was confirmed.

Carpal Tunnel Syndrome↗
PubMed2000

Evaluation of bifid median nerve with sonography and MR imaging.

Bifid median nerve is an anatomic variation that may be associated with carpal tunnel syndrome. It is important for the surgeon to be aware of the existence of this condition preoperatively in order to plan the carpal tunnel release. We report the correlation between ultrasonographic findings and magnetic resonance imaging results in six patients with bifid median nerve, selected from a population of 294 patients with carpal tunnel syndrome, who were studied by ultrasonography using a high frequency transducer. Sonography showed two structures inside the carpal tunnel with the same pattern as the median nerve in all six patients. Magnetic resonance imaging confirmed the sonographic findings. The patients underwent open surgery, and a bifid median nerve was found. In conclusion, bifid median nerve is an anatomic variant that can be demonstrated ultrasonographically. It is important to be aware of this anomaly when planning carpal tunnel release surgery.

Adolescent↗
PubMed2000

[Role of color Doppler echography in the visualization of perianal fistulae with injections of physiologic solutions].

PURPOSE: To prove the diagnostic value of color Doppler US in the evaluation of perianal external fistulae, using an endocavitary probe and a saline solution injection, in order to show the location of the fistulae, their extension, possible secondary tracts, residual abscesses and the relationship with adjacent tissues. MATERIAL AND METHODS: From October 1999 to December 1999, thirty-five consecutive patients (21 males and 14 females, mean age 47.5) affected with Crohn's disease were examined prospectively. These patients presented postoperative recurring external perianal fistulae. From this first group, 10 patients (6 males and 4 females, mean age 45) were selected as the external fistula was open. A biplanar transrectal 7.5 MHz probe was used for the examination. First the external opening of the fistula was cannulated with a soft plastic catheter. Then the probe, covered with a lubricated condom filled with US gel, was introduced into the anal canal (males) or the vagina (females). An initial gray-scale US study was performed. Finally the color-box was positioned on the tract, the Pulse Repetition Frequency (PRF) adjusted and the saline solution introduced. The study was completed with axial and linear scans. RESULTS: The mean examination duration was 31 minutes. Only two patients found the examination annoying because of partial anorectal stricture. The wall layers and their thickness were clearly located and distinguished. Gray-scale US showed the local anatomy in all patients. In 4 patients it depicted the primary fistula as a thin hypoecoic line (40%, three intersphinteric and one transphinteric). Color Doppler US detected the fistula in all patients (100%, seven intersphinteric and three transphinteric). Moreover it showed 2 small secondary tracts in 2 patients. No abscesses were found at the time of the examination. In the patients who underwent a second operation, surgical findings showed a good correlation (90-100%) with color Doppler findings. DISCUSSION AND CONCLUSIONS: This study demonstrated a greater diagnostic value of endosonography with color Doppler and saline solution injection as compared to conventional gray-scale endosonography in the evaluation of fistulae. Since this technique is also cost-effective and well tolerated by most patients we conclude that at present it makes an important diagnostic tool in the preoperative assessment of perianal fistulae.

Adult↗
PubMed1997

Tubercular epididymitis and orchitis: US patterns.

For several decades tuberculosis has been adequately under control in this country, but there has been recent concern that this disease might be coming back to the forefront, due to the influx of immigrants from developing countries where tuberculosis is still rampant. In the years to come we are expecting an increase in cases of genitourinary lesions of tubercular origin, a disease which had practically disappeared in the Western world. The aim of this pictorial essay is to provide an outline of the typical US images of tubercular epididymitis and orchitis.

Epididymitis↗
PubMed1996

[Urography with magnetic resonance: a new method for the study of the renal collecting system in patients without obstructive uropathy].

A new MR technique is proposed to study the renal collecting system and the proximal ureteral portion in patients without obstructive uropathy, using fat-suppressed Turbo Spin Echo sequences, after drug-induced distension of the urinary tract. Nine normal volunteers and 16 patients (11 with renal stones, 1 with bilateral pyeloureteral junction stenosis, 1 with renal ptosis, 1 with ureteral hyperkinesia, 1 with renal tumor and 1 with a symptomatic renal cyst) were submitted to MR-Urography, performed with a 3D non-breath-hold fat-suppressed Turbo SE sequence (TR = 3000 ms, TE = 800 ms, 6 acquisitions, Turbo Factor = 128, Matrix = 128 x 256 or 256 x 256, acquisition time = 5 min 15 sec or 10 min 36 sec) on the coronal plane. With these acquisition parameters, parenchymal signal can be completely suppressed while enhancing fluid signal. These acquisitions were post-processed with the MIP algorithm to obtain very similar images to those of conventional urography. The maximum filling of the renal collecting system was obtained with the i.v. administration of 250 ml saline solution within 2-3 minutes and then the i.v. injection of 20 mg furosemide. The renal collecting system was optimally depicted in all the volunteers and the patients, except for 2 cases because of malfunctioning respiratory gating. Anatomical detailing was really improved after the diuretic administration, especially in the study of the major caliceal systems. To conclude, MR-Urography permits accurate morphological detailing of the renal collecting system also in patients without obstructive uropathy.

Adult↗
PubMed1993

[Transrectal echography in the assessment of anastomosis and local recurrence after prior resection].

The value of rectal endosonography was investigated in the follow-up of the patients submitted to anterior resection for rectal cancer. Rectal endosonography was performed on 42 patients who had been operated on two months to five years before; all patients were monitored according to a carefully planned follow-up schedule including clinical and instrumental examinations and laboratory tests. Sixteen patients had altered clinical and laboratory data; 26 were completely asymptomatic. In the latter group, no signs of local recurrences were found, while in 4 cases the rectal wall appeared homogeneously thickened and hypoechoic: this pattern was due to postoperative or post-irradiation hyperemic-edematous phenomena. In 14 of 16 symptomatic patients, a mass was detected--in 9 of them inhomogeneous and hypoechoic and developing mainly in the perirectal perianastomotic tissue and in 5 limited to the rectal wall, in the anastomotic area. In the last 2 cases, no lesions were found. Both the manual and the stapler anastomoses were always demonstrated, which exhibited different US patterns. US findings were compared with histologic results or were clinically checked in the subsequent follow-up. To conclude, rectal endosonography proved to be useful in the postoperative follow-up of this kind of patients even though it did not allow the differential diagnosis between fibrosis and local recurrence.

Anastomosis, Surgical↗
PubMed1992

[Locoregional staging of cancer of the rectum with transrectal echography].

Accurate preoperative staging of rectal cancer is very important for both prognosis and the choice of surgical approach. The authors report the results obtained by means of endorectal US in the locoregional staging of medium-low rectal neoplasms. The TNM UICC 1988 classification was considered as reference. US findings were compared with histologic results. Thirty-seven patients with rectal cancer were studied with endorectal US; they had been selected on the basis of rectal examination findings, of combined endoscopy and biopsy, and barium enema results. US was performed only when the lesion was confined within 13 cm from the anal edge. US and histologic findings were compared in 32 of 37 patients; in 2 cases surgery could not be performed, and 3 patients could not undergo US due to the presence of a tight rectal stenosis. Overall US sensitivity was 87.5%. T1 (2 cases) and T4 (2 cases) staging was always correct; 2 of 16 patients were understaged as T2 (T3), while 2 of 12 were overstaged as T3 (T2). In conclusion, endorectal US appears to be an accurate method for the locoregional staging of rectal cancer.

Adult↗