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Enrico Fiori

Publications and source records attributed to Enrico Fiori.

11 recordsLinked to original sources
PubMed2005

Colorectal polyps: detection with low-dose multi-detector row helical CT colonography versus two sequential colonoscopies.

PURPOSE: To prospectively evaluate the diagnostic accuracy of low-radiation-dose computed tomographic (CT) colonography for detection of colorectal polyps by using two sequential colonoscopies, with the second colonoscopy as the reference standard. MATERIALS AND METHODS: The study was local ethics committee approved, and all patients gave written informed consent. Colonographic images were acquired by using a low-dose multi-detector row CT protocol (effective milliampere-second setting, 10 mAs). Three observers interpreted the CT colonographic data separately and independently by using a two-dimensional technique. Initial conventional colonoscopy was performed by an endoscopist unaware of the CT colonographic findings. Second colonoscopy performed within 2 weeks by a colonoscopist aware of both the CT colonographic and the initial colonoscopic findings served as the reference standard. The sensitivities of CT colonography and initial colonoscopy were calculated on a per-polyp and a per-patient basis. Specificities and positive and negative predictive values also were calculated on a per-patient basis. RESULTS: Eighty-eight patients underwent CT colonography and initial conventional colonoscopy on the same day. Per-polyp sensitivities were 62% and 83% for CT colonography and initial colonoscopy, respectively. Sensitivities for detection of polyps 6 mm in diameter or larger were 86% and 84% for CT colonography and initial colonoscopy, respectively. Initial colonoscopy failed to depict 16 polyps, six of which were correctly detected with CT colonography. For identification of patients with polyps 6 mm in diameter or larger, CT colonography and initial colonoscopy, respectively, had sensitivities of 84% and 90%, specificities of 82% and 100%, positive predictive values of 70% and 100%, and negative predictive values of 91% and 95%. CONCLUSION: Low-dose CT colonography compares favorably with colonoscopy for detection of colorectal polyps 6 mm in diameter or larger, with markedly decreased performance for detection of polyps 5 mm in diameter or smaller.

Aged↗
PubMedDate not supplied

Hürthle cell tumors of the thyroid gland. Personal experience and review of literature.

BACKGROUND: Oncocytic cell neoplasm of the thyroid is currently recognized as a histological entity, but doubts still exist about its clinical and evolutionary categorization. Controversies concern occurrence and frequency of malignant forms, natural history and therapeutic strategies. MATERIALS AND METHODS: The authors report six cases of Hürthle cell tumor. Five cases were adenoma, one was carcinoma. Morpho-functional pre-operative evaluation and inter-operative histopathological test were performed in all patients. One patient underwent lobectomy (absence of unusual characteristics of the adenoma Hürthle cell) and five underwent total thyroidectomies (1 carcinoma). All patients were treated with suppressive hormonal therapy. RESULTS: No mortality and morbidity was recorded. All patients are undergoing follow-up (adenomas: average 64.2 months; carcinoma: 132 months) and none of them show recurrent symptoms. DISCUSSION: Hürthle cell tumors can be diversified in adenoma and carcinoma. Almost all reports classify oncocytic nodules as malignant when capsular and/or vascular invasion is present or when there is peri-thyroid tissue infiltration or lymphatic or hematic metastases. A clear differentiation between adenoma and carcinoma is determined by a histological test. Also an intra-operative histopathological analysis is sometimes unable to show minimal signs of invasion. Conflicting observations about the biological behaviour of Hürthle cell neoplasm lead to different therapeutic strategies. The authors believe lobectomy is the treatment of choice when a clear histological diagnosis of adenoma has been made. When carcinoma is diagnosed or when doubts exist after intraoperative histological test, the authors recommend total thyroidectomy followed by scintigraphic test and preventive radio-active therapy. All patients should be treated with suppressive hormonal therapy and undergo periodic check-ups.

Adenoma, Oxyphilic↗
PubMedDate not supplied

Hepatocyte ultrastructural aspects after preoperative biliary drainage in pancreatic cancer patients with cholestatic jaundice.

BACKGROUND: The usefulness of preoperative biliary drainage in long-standing obstructive jaundice remains controversial. This study was designed to assess microscopic and ultrastructural changes in the morphology of hepatocytes from patients with obstructive jaundice treated with biliary drainage for 14 days. PATIENTS AND METHODS: In 8 patients with jaundice due to pancreatic neoplasms we obtained two fine-needle liver biopsies: the first during a transhepatic cholangiographic examination before placing preoperative drainage and the second at surgery, on day 14 of drainage. Biopsy samples were examined by light and electron microscopy and correlated to serum liver functional tests recorded before and after biliary drainage. RESULTS: Pre-drainage biopsy presented diffuse morphological signs of congestion and cholestasis, lipid and bilirubin cytoplasm inclusions, loss of bile canaliculi microvilli and diffuse bile canaliculi dilatation. After-drainage biopsies presented reduction of bile canaliculi dilatation, partial restoring of bile canaliculi microvilli and persistence of diffuse hepatocyte structural and ultrastructural changes. Patients' laboratory values (bilirubin, alkaline phosphatase, SGGT, SGOT and SGPT), that were significantly impaired before drainage, returned almost to normal within two weeks after drainage. CONCLUSION: Preoperative biliary drainage in patients with long-standing obstructive jaundice has received wide yet controversial support due to a well established pathophysiological background. The present findings of scarce recovery of hepatocyte changes after 14 days' drainage seemingly question its appropriateness.

Aged↗
PubMedDate not supplied

Comparative analysis of clinical features and prognostic factors in resected bronchioloalveolar carcinoma and adenocarcinoma of the lung.

BACKGROUND: Over the past few years, clinical, radiological and pathological classification of lung adenocarcinoma and its subtypes, particularly bronchioloalveolar carcinoma (BAC), has radically changed. PATIENTS AND METHODS: Out of a series of 384 non-small cell lung cancer (NSCLC) patients, submitted to surgical resection and followed-up in our Department from 1981 to 1999, the data of 151 adenocarcinomas (35 BAC and 116 non-BAC) were reviewed and analyzed for prognosis. RESULTS: BAC and non-BAC series were similar in clinical and radiographic findings, type of resection and stage. Stage I was a dominant favorable prognostic factor (10-year survival: 58% of BAC, 41.2% of non-BAC), albeit associated with a significant risk of second primary metachronous lung tumor (10-year risk: 25% of BAC, 32% of non-BAC). Other independent prognostic factors were: absence of lymph node involvement for BAC and stage III-IV for non-BAC. In term of prognosis, advantages of BAC over non-BAC were fewer cases with lymph node involvement, increased presence of "well-differentiated" cells (p = 0.016) and lower incidence of a second primary metachronous tumor. Moreover BAC patients with a single nodule or mass also had a higher survival expectancy (mean survival: 77 months versus 56 for non-BAC). An unfavorable feature was the higher incidence of diffuse or multicentric radiological forms (p = 0.012). For both groups the presence of multiple or satellite nodules remain a diagnostic and surgical challenge: in BAC cases the evaluation of clonality is recommended.

Adenocarcinoma↗
PubMedDate not supplied

Palliative management of malignant rectosigmoidal obstruction. Colostomy vs. endoscopic stenting. A randomized prospective trial.

BACKGROUND: Colostomy was the palliative treatment of choice in patients with malignant unresectable rectosigmoid obstruction. Palliative endoscopic treatment of malignant rectosigmoid obstruction by endoluminal self-expanding metallic stents is nowadays a well-established procedure. PATIENTS AND METHODS: Twenty-two patients, referred for treatment with diagnosis of malignant obstruction of the rectosigmoid region presenting an advanced unresectable stage, were enrolled. Patients were randomly assigned into two treatment groups (endoscopic stenting vs colostomy) according to random-number tables. The length of procedure, morbidity and mortality rate, canalization of the gastrointestinal tract, restoration of oral intake and hospital stay were assessed. RESULTS: Endoscopic group: The median length of procedure was 36 minutes. No death was observed. None of the patients reported complications. All patients resumed bowel function within 24 hours. The restoration of oral intake was achieved one day after stent placement. The median hospital stay was 2.6 days. Colostomy group: The median length of the operation was 75.4 minutes. No mortality was reported. In 1 patient (9.1%) stoma prolapse was observed 3 days after the operation. Canalization of the gastrointestinal tract was restored when colostomy was opened (on postoperative day 3). All patients were able to resume oral feedings on postoperative day 3. The median hospital stay was 8.1 days. CONCLUSION: There were no statistically significant differences between the 2 groups concerning morbidity and mortality. Endoscopic stenting was significantly more effective concerning operative time, restoration of bowel function and oral intake and median hospitalization. Our results would suggest that endoscopically placed metal stents offer an effective alternative to surgical palliation in patients suffering from unresectable malignant rectosigmoid obstruction.

Aged↗
PubMedDate not supplied

Palliative management of malignant antro-pyloric strictures. Gastroenterostomy vs. endoscopic stenting. A randomized prospective trial.

BACKGROUND: Gastroenterostomy was the palliative treatment of choice in patients with malignant unresectable gastric outlet obstruction. Palliative endoscopic treatment of malignant gastric outlet obstruction with endoluminal self-expanding metallic stents is nowadays a well-established procedure. PATIENTS AND METHODS: Eighteen patients referred for treatment with diagnosis of malignant strictures of the antro-pyloric tract presenting at an advanced unresectable stage. The patients were randomly assigned into two treatment groups (endoscopic vs. surgery) according to random-number tables. The length of procedure, morbidity and mortality rate, restoration of oral intake and gastric emptying at 8, 15 days and 3 months from treatment and hospital stay were assessed. RESULTS: Endoscopic group: The median length of procedure was 40 minutes. No death and one minor complication (11.1%) was reported. Mean time for oral intake was 2.1 days. Gastric emptying was satisfactory in 88.9% after 8 days and in 100% of patients after 15 days and 3 months. The median hospital stay was 3.1 days. Surgery group: The median length of the operation was 93 minutes. No mortality was reported. One patient (11.1%) developed anastomotic bleeding which required relaparotomy. Mean time for oral intake was 6.3 days. Gastric emptying was satisfactory in 66.7% of patients after 8 days, in 88.9% after 15 days and in 100% after 3 months. The median hospital stay was 10 days. CONCLUSION: There were no statistically significant differences between the 2 groups even with respect to morbidity, mortality, delayed gastric emptying and clinical outcomes at 3-month follow-up. Endoscopic stenting was significantly more effective with respect to operative time, restoration of oral intake and median hospitalization. Our results would suggest that endoscopically placed metal stents offer an effective alternative to surgical palliation in patients with unresectable malignant strictures.

Aged↗
PubMedDate not supplied

Significance of T stadium and grading as prognostic factors in transitional cell carcinoma of the ureter.

BACKGROUND: Surgery is nowadays the standard treatment for carcinoma of the ureter, even if adjuvant therapies can modify the prognosis in selected patients. Because of the small number of patients in the literature series, the significance of prognostic factors that can be used in clinical practice is still controversial, as is the choice of the most suitable surgical and adjuvant treatment. PATIENTS AND METHODS: We considered 27 consecutive patients (Ta-T2 N0 M0) who underwent radical surgery (nephroureterectomy with bladder cuff excision and lymphoadenectomy) for transitional cell carcinoma of the ureter, from 1982 through 1992. Seven patients (25.9%) had Ta tumors, 7 patients (25.9%) had T1 tumors and 13 patients (48.2%) had T2 tumors. In 4 cases (14.8%) the tumor was well-differentiated (G1), in 14 cases (51.8%) it was mildly-differentiated (G2), and in 9 cases (33.4%) it was poorly-differentiated. RESULTS: Thirteen of the 14 patients affected by Ta-T1 tumors were alive 10 years after surgery (one patient lost at follow-up); in the T2 tumor group the 5-year survival rate was 84.6% and 10-year survival rate was 69.2%. According to grading, the 10-year survival rate was 100% for G1 tumors, the 3, 5 and 10-year survival rates were, respectively, 100%, 92.8% G3 tumors. CONCLUSION: Data from our study show the significance of the T stage and grading as prognostic factors.

Aged↗
PubMedDate not supplied

Lymph node dissection in papillary or follicular thyroid carcinoma.

BACKGROUND: Prospective randomized studies aimed at evaluating the different therapeutic protocols for the treatment of papillary or follicular carcinoma are lacking at the moment. Although total thyroidectomy is widely accepted, indication to locoregional lymphadenectomy is strongly debated. MATERIALS AND METHODS: Fifty-four patients with papillary or follicular thyroid carcinoma (45 papillary and 9 follicular) underwent functional evaluation of the gland before intervention, FNAB included Surgical management was carried out as follows: 41 total thyroidectomy, 6 lobectomy with further totalization in 5, 6 total thyroidectomy plus central compartment lymphadenectomy and 1 left laterocervical lymphadenectomy (papillary carcinoma, treated elsewhere through total thyroidectomy plus central and right laterocervical lymphadenectomy). All operated patients were submitted to whole body scintigraphy and treated thereafter by radiometabolic therapy and chronic hormone suppressive therapy. RESULTS: Fifty-one patients are currently alive, 3 died from non-related causes; surgical complications included 1 permanent impairment of inferior laryngeal nerve function and 1 case of hypoparathyroidism. The follow-up was from 1 to 139 months. DISCUSSION: The optimal treatment of lymph node metastases, especially for papillary carcinomas, has not yet been defined. Two trends are evident concerning lymphadenectomy: the first one suggests routine lymphadenectomy, the second supports lymphadenectomy by necessity. In follicular carcinoma lymphadenectomy is recommended only in the presence of clinical evidence of lymph node involvement. Occult differentiated carcinoma does not require any further treatment of lymph nodes. CONCLUSION: Considering the high efficacy of radiometabolic treatment after total thyroidectomy combined with chronic TSH inhibition through L-tyrosine administration, lymphadenectomy is suggested only by necessity.

Adenocarcinoma, Follicular↗
PubMedDate not supplied

Malignant intestinal obstruction: useful technical advice in self-expanding metallic stent placement.

BACKGROUND: The use of endoluminal self-expanding metallic stents is an effective alternative to surgery in neoplastic gastrointestinal tract obstructions. It is often difficult to mark the proximal segment of the stricture under fluoroscopic guidance (due to patient movements or change of markers' position). PATIENTS AND METHODS: We placed Ultraflex precision colonic stent (Microvasive, Boston Scientific) in ten patients with neoplastic stricture of the rectosigmoid colon. Before placement of the delivery catheter, a radiopaque proximal marker was identified on the delivery catheter under fluoroscopic guidance. The external side of the delivery catheter was coloured (in correspondence with the radiopaque marker) with non toxic colour. After the introduction of the delivery catheter, we placed the proximal coloured marker just above the distal tumour margin under endoscopic guidance. RESULTS: The procedure was successful in relieving the obstruction in all patients, without mortality or complications. In all patients the coloured marker was identified and the stent correctly placed. CONCLUSION: The location of a coloured marker in the external side of the delivery catheter permits an accurate and correct placement of the stent, without unnecessary exposure to X-rays.

Catheterization↗
PubMedDate not supplied

Malignant fibrous histiocytoma of the breast. Report of two cases and review of the literature.

Sarcomas of the breast are uncommon, accounting for less than 1% of all primary malignancies. Among these tumors, malignant fibrous histiocytoma (MFH) is very rare. Two cases of this neoplasm are reported, with histological findings and surgical treatment. The issue of radiation-induced lesions after surgery for carcinoma and the necessity for a correct preoperative diagnosis is examined. A review of the available literature evaluates the histopathological and biological features of MFH of the breast, for which there are no prospective trials, owing to the rarity of this kind of neoplasm. The extent of surgery or role of axillary lymph nodes dissection and multimodality therapy are discussed.

Adult↗