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G C Ettorre

Publications and source records attributed to G C Ettorre.

At least 19 recordsLinked to original sources
PubMed2006

Double-contrast MRI (DC-MRI) in the study of the cirrhotic liver: utility of administering Gd-DTPA as a complement to examinations in which SPIO liver uptake and distribution alterations (SPIO-LUDA) are present and in the identification and characterisation of focal lesions.

PURPOSE: The aim of this study was to compare the performance of double-contrast magnetic resonance imaging (DC-MRI) with the sequential use of superparamagnetic iron oxide (SPIO) and gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA) contrast agents compared with unenhanced MRI and SPIO-enhanced MRI (SPIO-MRI) in the study of the cirrhotic liver. Special attention was paid to cases in which alterations of liver uptake and distribution of the SPIO contrast medium [SPIO-liver uptake and distribution alterations (SPIO-LUDA)] could lead to diagnostic errors at SPIO-MRI. MATERIALS AND METHODS: We used DC-MRI to study 67 patients suffering from hepatic cirrhosis and on a waiting list for liver transplant. The study was performed with a 1.5-Tesla device and characterised by three phases: the first phase without contrast material (unenhanced MRI), the second after the administration of ferumoxides (SPIO-MRI), and the third, a double-contrast study following the injection of a bolus of paramagnetic contrast material (DC-MRI). The sensitivity of unenhanced MRI, SPIO-MRI and DC-MRI in identifying and characterising hepatic focal lesions was assessed, together with the diagnostic increment of one technique with respect to the others. The gold standard was histological confirmation in 38 cases and clinical-radiological follow-up in all cases. Liver function, kidney function, blood tests and urinalysis were performed in all patients 24-48 h before and after the MRI examination. RESULTS: In 14/67 cases (20.8%), SPIO-LUDA were present, which posed a limitation to the SPIO-MRI examination. Focal lesions were absent in 44 patients, and the action of the ferumoxides was reduced by the presence of SPIO-LUDA in nine cases. There were five cases of confluent fibrosis, two of decompensated cirrhosis, one of vascular thrombosis, and one of scarring in a patient who had undergone hepatic resection for hepatocellular carcinoma (HCC). In all these cases, completion of the MR examination with the DC technique clarified the MR picture, confirming the absence of focal lesions. Twenty-three patients had a total of 68 lesions, which consisted of 37 dysplastic nodules (DN), 19 HCC nodules, two relapses of HCC following chemoembolisation, two HCC associated with portal thrombosis, one cancer-cirrhosis, two angiomas and five small cysts. SPIO-LUDA were present in five patients, thus limiting the identification, characterisation or assessment of the real size of the lesions. SPIO-LUDA were the result of vascular thrombosis in one case and fibrosis in four cases. In all of these cases, DC-MRI proved useful for diagnosis. The sensitivity of unenhanced MRI, SPIO-MRI and DC-MRI for lesion detection was 57.3%, 67.6% and 75%, respectively. The results obtained in the characterisation of the lesions were 20.5%, 63.2% and 73.5% for unenhanced MRI, SPIO-MRI and DC-MRI, respectively. The diagnostic increment of SPIO-MRI over unenhanced MRI for lesion identification and characterisation was 9% and 42.7%, respectively, whereas the diagnostic increment of DC-MRI over SPIO-MRI was 7.4% and 10.3%, respectively. CONCLUSIONS: In our study, the combined use of two contrast agents, negative and positive, provided greater diagnostic confidence and caused no side effects in the patients.

Contrast Media↗
PubMed2006

Endovascular treatment of pulmonary and cerebral arteriovenous malformations in patients affected by hereditary haemorrhagic teleangiectasia.

Hereditary Haemorrhagic Teleangiectasia (HHT) is a vascular disorder of angiogenesis transmitted in an autosomal dominant pattern, characterised by heterogeneity in clinical manifestations. One of the most important organ involved is lung, including pulmonary arteriovenous malformations (PAVM). PAVM occur in 20 to 30% of the HHT population and recently are considered a marker of disease. PAVM are direct artery-to-vein connections with low pressure and without an interveining capillary bed. PAVM are classified as simple (supplied by one feeding artery) or complex (receiving blood supply from two or more feeding artery). According to the international reports, treatment it's recommendable for all PAVM with feeding vessels 3mm or larger, in order to reduce the risk of cerebral ischaemia and neurologic manifestations frequently attributed to paradoxical embolisation. Transcatheter embolotherapy of PAVM is a form of treatment based on occlusion of the feeding artery to a PAVM by using platinum coils or detachable balloons. The technique of coil embolisation involves the exact localisation of PAVM by pulmonary angiography followed by superselective percutaneous caheterisation of feeding artery obtained by using a dedicated 7F guiding catheter, which coaxially allocates a 5F hydrophilic catheter advanced in order to perform both superselective angiography of feeding artery and embolisation itself. Inside the 5F catheter the platinum coils are advanced using a .035'' guide-wire and released until an optimal occlusion of feeding artery is achieved. At the end of the procedure angiographic control is performed in order to verify the occlusion of feeding artery. The use of platinum coils is preferable over detachable balloons when feeding artery are greater than 7 mm in diameter and have irregular anatomical configuration. On the other hand, the principal advantage of using detachable balloons is that the balloon itself can be deflated and repositioned if necessary. Transcatheter embolotherapy is technically safe and clinically effective and may represent the primary choice of treatment in HHT patients. On the other hand the most common complications of this treatment (pleurisy and air embolism) can be prevented by using some tips during the embolisation procedure like "anchor technique," "scaffold technique" and "balloon assisted technique." Cerebral arteriovenous malformations (CAVM) are present in 10-20% of patients with HHT and multiple in 50% of cases. Cortical surface is the most frequent localisation. Angiography is needed to diagnose all CAVM and to clarify the angioarchitecture of the lesion. In HHT CAVM are usually either micro-AVM, with a nidus not bigger than 1 cm, or small AVM, with a nidus between 1 and 3 cm. Quite frequently there are lesions characterised by arteriovenous fistulas. In the three patterns of CAVM usually found in HHT, small AVM are the most risky for bleeding although the risk is lower than that associated with sporadic ones. It is estimated from 0.38 to 0.69% per year in spite of the general incidence of bleeding in sporadic CAVM that ranges from 2 to 4% per year. In HHT patients, at present, the precise indications and timing of treatment are not established. Trend is to treat small AVM and AVF and to follow-up micro-AVM with MRI and angiography. As for sporadic CAVM, treatment of small AVM is usually referred to stereotactic radiosurgery. Endovascular embolisation is proposable if the lesion is easily reachable by microcatheterism and the position of the microcatheter is safe. Glue is used for embolisation and the technique is briefly discussed.

Angiography↗
PubMed2000

[Renal arteriovenous fistulas after renal biopsy. Percutaneous embolization].

PURPOSE: We report our experience relative to transcatheter percutaneous embolization of post-biopsy renal intraparenchymal arteriovenous fistulas in patients with chronic renal insufficiency. MATERIAL AND METHODS: We observed 5 patients affected with post-bioptic fistulas for possible embolization. In three cases the symptoms were represented by intermittent macro-microhematuria; one patient had hypertension of nephrovascular origin and one patient was asymptomatic. In all cases we performed angiography and it was possible to catheterize the peripheral afferent branch of the fistula with a superselective technique using a hydrophilic guide of 0.035 F and a hydrophilic Cobra catheter of 4-5 F. The occlusion was obtained by the positioning of Granturco metal coils: in 1 case we adapted a coil of 3 mm diameter and 1 cm length; in 3 cases 2 coils of 3 mm and in 1 case 2 coils of 3 mm and 1 coil of 5 mm diameter and 1 cm length were necessary. The success of the procedure was always checked with an immediate angiogram and color Doppler US after 48 hrs. RESULTS: The diagnosis of arteriovenous fistulas was always confirmed by a preliminary angiography that demonstrated the normal anatomic disposition of the renal arteries except in one case in which the fistula was fed by a peripheral branch originating from an inferior polar artery. All the lesions were localized in the inferior pole, the site of biopsy, and ranged from 3 mm to 2.5 cm in diameter. We never had any difficulties in the positioning and placement of the coils. The arterial occlusion and exclusion of the fistula was accomplished in all cases. The induced parenchymal loss ranged from 10 to 30% of the renal volume. There was a complete disappearance of symptoms in 3 of the patients, with hematuria without any modification of the blood pressure values in the patient with hypertension. Considering the patient status renal function did not worsen after the embolization. Each patient was followed-up with color Doppler US every two months. CONCLUSIONS: The intrarenal arteriovenous fistula represents a relative frequent complication of renal needle biopsy in patients with arterial hypertension and nephroangiosclerosis as risk factors. Embolization is a valid alternative therapeutic option to surgical treatments. The use of small size catheters permits the successful embolization also of peripheral lesions, reducing the induced parenchymal ischemia. We believe that among the embolization material available metal coils represent a valid solution as they are easily positioned and permit definitive occlusion without any risks of systemic venous microembolization.

Adult↗
PubMed2000

[Evaluation of hemodynamic significance of arteriovenous coronary fistulas: diagnostic integration of coronary angiography and stress/rest myocardial scintigraphy].

PURPOSE: We report on the importance of the integration of data obtained from digital coronary angiography and stress/rest 99mTc sestamibi myocardial perfusion single photon emission tomography in evaluating the hemodynamic significance of coronary arteriovenous fistulae. MATERIAL AND METHODS: Coronary fistulae were detected with coronary angiography in 9 patients. All patients underwent clinical examination, transthoracic echocardiography, stress electrocardiogram and stress/rest 99mTc sestamibi myocardial perfusion single photon emission tomography. RESULTS: Stress/rest 99mTc sestamibi myocardial perfusion single photon emission tomography and stress electrocardiogram showed stress-induced myocardial ischemia in 2 patients. The first patient with familial predisposition and risk factors for ischemic heart disease presented a mesocardic heart murmur on clinical examination. At stress ECG (125 Watt, 153 b/m' max frequency 93%, arterial pressure 230 mmHg, max frequency pressure product 35,200) ischemic alterations were recorded at the first minute of the second stage of the Bruce protocol. Coronary angiography detected a circumflex artery fistula in the coronary sinus. Stress/rest 99mTc sestamibi myocardial perfusion single photon emission tomography for the evaluation of stress/rest perfusion detected a reversible perfusion defect of the proximal portion of the posterolateral and lateral walls, thus confirming the hemodynamic importance of the flow through the fistula during stress cycloergometric testing. In the second patient familial predisposition to ischemic heart disease and previous inferior wall myocardial infarction and non-significant stress ECG, coronary angiography identified a subocclusive stenosis of the right coronary artery and an anomaly between the anterior interventricular artery and the left pulmonary artery. The presence of the contrast medium in the left pulmonary artery identified a flow from the left ventricle to the left pulmonary artery. Good angiographic results were obtained after percutaneous coronary angiography of the right coronary artery stenosis. Due to the onset of angina stress/rest 99mTc sestamibi myocardial perfusion single photon emission tomography was performed to evaluate stress/rest perfusion (75 Watt, 125 b/m', 88% max frequency, arterial pressure 200 mmHg, double max product 25,000 with ST depression of 1.5 mm in V1-V4) and identified an irreversible perfusion defect due to infarction and a reversible perfusion defect of the anterior wall and apex due to ischemia caused by the anomalous flow through the coronary fistula. The correspondence between the site of the coronary artery where the fistula originates, identified by coronary angiography, and the reversible perfusion defects, identified by stress/rest 99mTc sestamibi myocardial perfusion single photon emission tomography, indicates that the anomalous flow through the fistula may cause myocardial ischemia. The irreversible perfusion defects of the inferior wall are the result of right coronary artery subocclusive stenosis. CONCLUSIONS: Coronary fistulae cause myocardial ischemia only in a small number of patients. Data obtained from single photon emission tomography in evaluating stress/rest myocardial perfusion, correlated with data from coronary angiography, have shown that changes in patients with terminal coronary anomalies may be due to different coronary diseases: ischemia to anomalous flow through the fistula and myocardial infarction to subocclusive right coronary artery stenosis. Stress/rest 99mTc sestamibi single photon emission tomography for the evaluation of myocardial perfusion is a reliable means of assessing the functional importance of the terminal coronary anomalies detected by coronary angiography. Evaluation of the hemodynamic importance of the coronary fistulae is indispensable in programming corrective surgery.

Adult↗
PubMed1998

Aneurysms of the supra-aortic trunks in Takayasu's disease. Report of two cases.

Takayasu's arteritis is a chronic inflammatory disease of unknown etiology, which affects the aorta and its branches. The resulting lesions can be of steno-occlusive or aneurysmatic type; the latter form is relatively rare. The authors report 2 cases which came under their observation for treatment. The first was a young man of 22 years with aneurysm of the common right carotid artery and of the subclavian left intrathoracic artery. The carotid aneurysm was operated first; arterial reconstruction was ensured by means of a dacron bypass as the saphenous vein was not usable. Three months later, exeresis of the subclavian aneurysm was performed with a left thoracotomy in the IV space. The postoperative course was uneventful and no untoward event has been observed during follow-up (15 months). The second case was a young girl of 16 years with poststenotic aneurysmatic dilatation of the anonyma artery, tight stenosis of the left renal artery and occlusion of the right renal artery. The patient underwent median sternotomy and removal of the aneurysmatic wall together with the stenosis, and a dacron patch was applied. During preoperative angiography, the stenosis of the left renal artery had been treated with PTA; one month after the first operation, a right aorto-renal bypass was fashioned with the saphenous vein. Postoperative stay was free from complications on both occasions and complete normalization of the pressure values was obtained, which persists after 12 months.

Adolescent↗
PubMed1997

Helical CT angiography in gastrointestinal bleeding of obscure origin.

OBJECTIVE: The aim of the study was to verify the usefulness of helical CT angiography for diagnosis of gastrointestinal hemorrhage of obscure origin. SUBJECTS AND METHODS: Eighteen consecutive patients underwent catheterization of the abdominal aorta followed by helical CT angiography before and after intraarterial injections of a contrast medium. Helical CT angiography revealed the site of hemorrhage as an extravasation of contrast medium resulting in a hyperdense area in the intestinal lumen. All patients then underwent conventional angiography that was selective for the 13 patients in whom helical CT angiography was positive and standard for the remaining five patients with negative helical CT angiograms. RESULTS: Helical CT angiography revealed the site of hemorrhage in 13 (72%) of 18 patients. Diagnosis of bleeding site was confirmed, and the cause was established at surgery in 11 of these 13 patients. The site of bleeding for the remaining two patients was confirmed by angiography as angiodysplasia of the jejunum (n = 1) and of the colon (n = 1). Of the five patients with negative helical CT angiograms, location of bleeding was revealed by conventional angiography in two patients; one of the remaining three patients underwent exploratory laparotomy; and bleeding ceased in the remaining two patients, who were treated without surgery. Conventional angiography was negative for two of the 13 patients in whom helical CT angiography was positive. CONCLUSION: Despite our limited experience, helical CT angiography proved to be an easier and faster technique than conventional angiography for localizing gastrointestinal bleeding of obscure origin and useful as a guide for subsequent selective conventional angiography.

Adult↗
PubMed1996

Fibrosarcoma of the thigh. Case report and literature review.

Sarcomas of the soft tissue constitute a fairly rare group of neoplasms localized mainly at the level of the extremities. Apart from clinical and semeiotic investigations, diagnosis is based on imaging techniques. Among these (ultrasound, CT, NMR and angiography), all of which are helpful in diagnosis, NMR seems to provide the most complete data and sensitivity and specificity. In fact, it has greater specificity than ultrasound or CT as regards identification of any infiltration of the muscle or deep interstitial tissues and can also contribute information on the nature of the sarcoma, as it provides high definition of the structural composition of the tissues. Angiography remains important as a preoperative guide to the surgical approach. Surgery is the treatment of choice, although in recent years it has been integrated with radio or chemotherapy. Thanks to the progress in treatment constituted by combination treatments there has been a dramatic reduction in the need for amputations, compartmental excision and disinsertion of muscle groups. We report the case of a patient with fibrosarcoma of the thigh and discuss the various imaging techniques and different approaches to the treatment of these neoplasms.

Adult↗
PubMed1995

[Spiral computed tomography with arteriography in the diagnosis of digestive system hemorrhages of obscure origin].

Some 5-20% of gastrointestinal (GI) bleeding cases are of obscure origin because bleeding is difficult to diagnose or locate with conventional imaging methods. The authors suggest arterial spiral CT (ASCT) of the abdomen as an original tool to study GI bleeding of obscure origin. This diagnostic method consists of two subsequent phases: first, after abdominal aorta catheterization, the catheter is positioned in the celiac artery; then, CT of the abdomen is performed before and after intra-arterial contrast agent injection. In 6 of 10 patients with GI bleeding of obscure origin, ASCT depicted small high-intensity areas in the intestinal lumen, which indicate a source of bleeding. The site of bleeding was studied only with topographic criteria according to scanning planes, and the morphological features of the intestinal segments were investigated. All patients were submitted to surgery: when ASCT identified a bleeding site, angiography was limited to the involved arterial district. Angiography alone could locate the source of bleeding in 5 patients; angiography and ASCT were in agreement in 4 patients. The combined techniques located the source of bleeding in 7/10 patients and the nature of bleeding was diagnosed in 3/10 patients (angiodysplasia). Even though their experience is limited, the authors believe that ASCT can be useful in locating GI bleeding of obscure origin, as well as in guiding subsequent selective angiography.

Adult↗
PubMed1993

Validity of echographic evaluation of cartilage in gonarthrosis. Preliminary report.

We studied an echographic technique by which precise reproducible measurements of articular cartilage thickness of the knee is possible. Two groups of individuals were studied: a group of 18 patients with gonarthrosis and a control group of 10 normal individuals. The group of 18 patients with gonarthrosis was studied by ultrasound (US) before knee prosthesis surgery. The cartilage thickness was measured within the weight-bearing area. US re-evaluation and histological measurements were made on the pathological specimen following the operation. Results of pre- and post-operative US data were compared with histological data. A good correlation between these measurements was found [P(t) > 10%]. In order to have comparative reference values of the articular cartilage within the weight-bearing area of the femoral trochlea a group of 10 control subjects was also studied with US as above. We found that the articular cartilage thickness of the femoral trochlea in the weight-bearing area has a mean of 2.2 +/- 0.3 mm for the lateral condyle and 2.3 +/- 0.2 mm for the medial condyle. The intra-observer and inter-observer difference in measurements was evaluated with Student's t-test. Our data demonstrate that US measurements of articular cartilage thickness of femoral condyles is a sensitive and reproducible technique which permits early diagnosis and management of knee arthropathy as well as quantification of cartilage damage.

Adolescent↗
PubMed1993

Articular cartilage echography as a criterion of the evolution of osteoarthritis of the knee.

We propose a modification of the Aisen's technique by which precise reproducible measurements of articular cartilage thickness of the knee is possible. A group of 23 patients with severe osteoarthritis was studied by ultra-sound (US) before knee prosthesis surgery. Evaluation with US was performed by a real-time scanner with a 7.5 MHz linear probe with upper-patellar transverse scans tangent to the upper patellar pole at 90 degrees knee flexion. The cartilage thickness was measured within the weight-bearing area. After surgery, on the corresponding gross pathological specimen, US re-evaluation and histological measurements were made. Results of pre- and post-operative ultrasonography (US) data were compared with histological data and a good correlation between these measurements was found (p(t) > 10%). Preoperative measurements ranged from 2.4 to 0.3 mm. In order to obtain normal reference values of the articular cartilage within the weight-bearing area of the femoral trochlea for comparison, a group of 10 control subjects was also studied with US as above. The US data were then compared with computed tomography (arthro-CT) evaluations. No significant differences in mean values were found between the two imaging techniques (2.2 mm versus 2.3 mm for the lateral condyle and 2.3 versus 2.3 for the medial condyle, respectively). We conclude that ultra-sound measurement of articular cartilage thickness of femoral condyles is a sensitive and reproducible technique which permits early diagnosis and management of knee arthropathy and also quantification of cartilage damage.

Adolescent↗
PubMed1993

[Diagnostic imaging of Tietze's syndrome. Comparison of computerized tomography and ultrasonography].

Tietze's syndrome is an uncommon disease characterized by the absence of any systemic symptom; imaging techniques play a major role in the diagnosis of this condition. A control group including 10 normal subjects and 4 patients with clinical evidence of Tietze's syndrome were submitted to US; 3/4 patients underwent CT too. In the lesion site, US demonstrated thickened cartilage and inhomogeneously increased echogenicity in 4 patients, blurred outline in 3 patients and a hypoechoic halo in 1 patient. CT showed thickened cartilage and blurred outline in 3 patients and hypodense cartilage in 1 patient. Both methods were very useful to diagnose the disease in all cases. The authors conclude that US plays a major role in the diagnosis of Tietze's syndrome thanks to its harmlessness, repeatability and cost-effectiveness.

Adolescent↗
PubMed1993

[The selective embolization of the hypogastric arteries in the treatment of hemorrhages due to cervical carcinoma. The report of 2 clinical cases].

Transcatheter arterial embolization (TAE) has been reported to effectively control bleeding in the gynecological and obstetric field. We report the use of selective hypogastric arteries embolization in the management of severe persistent cervical bleeding in two patients affected by advanced cervical cancer. Bleeding stopped in both cases; no serious side-effects were noticed. In a short time hematological status was restored and both patients had a long bleeding-free time. We consider TAE the treatment of choice in controlling persistent neoplastic cervical bleeding. Indications, usefulness and complications of such a technique are herein discussed.

Adult↗
PubMed1993

[Tendinopathy of the patellar ligament secondary to transtendineal arthroscopy of the knee. Ultrasonographic evaluation].

During knee arthroscopy, the transtendinous approach best visualizes articular structures, even though it may cause patellar tendinitis, following the surgical procedures. Thirty patients (22 men and 8 women) who had undergone transtendinous arthroscopy of the knee were submitted to clinical and US follow-up at 3, 6, 12 months. This monitoring was aimed at correlating clinical and instrumental findings of the above iatrogenic condition. Painful symptoms were present in 30% of the cases in group I, in 10% of group II and in no patient in group III. US demonstrated thickening of the patellar tendon in all the three groups of patients, with reduced echogenicity and blurred margins at the arthroscopic portal, plus decreasing gravity over time. The US pattern of arthroscopic surgical gap was observed in all patients in group I, in 10% of patients in group II and in none of the patients in group III. In conclusion because of its clinical course and of its US findings, in our experience patellar tendinopathy following transtendinous arthroscopy of the knee is not to be considered as a iatrogenic inflammatory or degenerative sequela, but as a physiological cicatricial evolution of the surgical transtendinous breach. The US follow-up of the latter allows the correct assessment of the recovering process.

Adult↗
PubMed1992

Histopathology of spontaneous brain herniations into the middle ear.

Two patients with spontaneous brain herniation into the middle ear have been operated on with a combined otoneurological approach. In case No. 1, two 2 x 3 mm arachnoid tissue herniations were found in the tegmen antri of the left ear. Six years later, a 8 x 9 mm mass consisting of prolapsed brain was removed from the right ear. The histological examination showed normal but disorganized nervous tissue. The surface consisted of middle ear mucosa or modified glial cells. More deeply numerous well preserved neurons and synapses were observed. In case No. 2, a 2 x 1 cm herniation was found in contact with the ossicles and the bony walls of the middle ear. The herniation consisted of partly degenerated nervous tissue which could explain the episode of temporal lobe seizure the patient experienced 8 years before surgery. In the world literature during the last 40 years, 29 cases of spontaneous or idiopathic brain herniation into the middle ear and mastoid have been reported. In 10, the herniations were multiple, as in our case No. 1. Case No. 1 is interesting also because the spontaneous brain herniation was bilateral.

Cerebrospinal Fluid Otorrhea↗
PubMed1992

Very far-advanced otosclerosis.

The term very far-advanced otosclerosis is proposed to indicate otosclerotic patients with both bone and air conduction thresholds nonmeasurable on a standard clinical audiometer (blank audiogram). Three of these patients have undergone stapedotomy with satisfactory results. This confirms that cochlear implantation is not the best treatment for all profoundly deaf patients at least with implants available today. Some of the patients with a blank audiogram are better off with exploratory tympanotomy and stapedotomy.

Adult↗