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Biomedical subjects

G Liessi

Publications and source records attributed to G Liessi.

At least 37 records · Page 2Linked to original sources

[Cholangiopancreatography with magnetic resonance. Clinical use of a new "inversion-recovery" sequence].

This study was aimed at correlating the yield of a three-dimensional (3D) inversion-recovery (IR) turbo spin-echo MR cholangiopancreatography (MRCP) sequence with that of ERCP and PTC in the imaging of the normal and abnormal biliopancreatic tract. Thirty patients with suspected biliary and pancreatic diseases were examined with MRCP first and then with ERCP or PTC; they were also submitted to US, CT and conventional MR studies and in 5 of them CT cholangiography was also performed. Five patients were normal and 25 had various obstructive abnormalities: 5 patients had gallbladder stones, 8 common bile duct stones, 5 a cholangiocarcinoma and 7 an adenocarcinoma of the pancreatic head or papilla. MRCP was performed with a superconductive magnet at 0.5 T, with volumetric images on coronal planes acquired using an IR turbo SE sequence (TR 2500, TE 1000, TF 89, 4 NEX) with respiratory triggering and vascular presaturation. Segmental intrahepatic bile ducts were correctly depicted in all the patients with benign or malignant obstruction of the common bile duct, but with some respiratory artifacts. Common bile duct stones were correctly depicted in 7 of 8 patients, but studying also the single coronal slices. With this method, the stones were clearly demonstrated in 22 examined gallbladders. Neoplastic obstruction and the obstruction level were correctly identified in all patients. Pancreatic ducts were shown in normal patients and in 8 of 13 patients with neoplastic or lithiasic obstruction of the common bile duct mainly on the pancreatic head. ERCP was carried out successfully in 5 patients with common bile duct stones and in 7 patients with neoplastic obstruction; in the other cancer patients, PTC was necessary. To conclude, respiratory-triggered 3D IR turbo spin-echo MRCP is a noninvasive technique to study mostly biliary conditions which yields similar information to ERCP and PTC in a large number of patients. Moreover, this sequence can be used with midfield MR units to study the obstruction of the biliary and pancreatic ducts not only when invasive techniques fail, but also routinely.

Adult↗

Solitary true cyst of the pancreas in adults. Report of three cases and review of the literature.

Solitary true cysts of the pancreas are extremely rare: to date, only eight cases have been reported in the English literature, four of which had clinical significance. An additional three cases of solitary true cysts of the pancreas are presented. One patient was incidentally found at operation, performed for other disease, to have a cystic lesion in the body of the pancreas; the other two patients experienced abdominal pain and nausea. Abdominal US, CT, and MR showed a unilocular cyst in the body and tail of the pancreas. In both cases, preoperative diagnosis of pancreatic cystic neoplasm was made. Two patients underwent excision of the mass and one distal pancreatectomy. Analysis of the cyst fluid revealed high CA 19-9 levels in two and CA 125 levels in one case. All cysts were lined by cuboidal epithelium, without morphological alterations. Preoperative differential diagnosis with the most common cystic pancreatic lesions (inflammatory or neoplastic) is difficult.

Adult↗

[Medial luxation of the long head of the brachial biceps. Magnetic resonance imaging].

The medial intraarticular dislocation of the biceps tendon of the shoulder is a rare pathologic condition and its diagnosis before surgery is very important to properly repair the tears of rotator cuff tendons, the rotator cuff being nearly always involved. We report our experience in 8 patients (1.8%) with biceps tendon dislocation observed in a series of 432 patients submitted to MR studies to address several diagnostic issues. The MR patterns of biceps tendon dislocation and the related physiopathologic mechanisms are discussed. The MR images were retrospectively reviewed by two of the authors and dislocations were diagnosed in a subgroup of 34 patients (7.8%), associated with full-thickness tears of the tendon of supraspinatus muscle; all patients also presented a full-thickness tear of the subscapularis tendon. A dislocated biceps tendon can follow a variety of courses depending on the pattern of subscapularis tendon tear. We always found a complete dislocation of the biceps tendon; other dislocation patterns reported in the literature, and particularly oblique and superficial dislocations, were never observed in our series. Dislocation is visible on axial images, where the tendon appears completely displaced from the bicipital groove, but also sagittal and coronal images can depict the more medial position of the tendon. In our patients this abnormality was correctly identified in 4 patients during the first observation and in the extant patients during the retrospective review. The dislocation of the biceps tendon of the shoulder was frequently associated with a complete tear of the supraspinatus tendon (23.5%). All patients exhibited severe joint effusion and in two patients the dislodged tendon was also inflamed.

Adult↗

Medical treatment of hepatocellular carcinoma: any progress?

BACKGROUND: Hepatocellular carcinoma (HCC) remains one of the most common neoplasms worldwide. Curative treatment options include liver transplantation or resection. Unfortunately, most patients still have unresectable or untransplantable HCC due to disease extension or comorbid factors and are therefore candidate only for palliative treatments. METHODS: In this review we have analyzed the different medical approaches employed in the treatment of HCC in an attempt to better define their roles. RESULTS: Palliative medical treatments including systemic chemotherapy, immunotherapy or hormonal manipulation rarely influence survival of the patients. Although a high response rate is often reported with new local therapies such as transcatheter arterial embolization, intraarterial chemotherapy or percutaneous ethanol injection, the real impact of these treatment modalities on patient survival remains to be determined. CONCLUSION: One way to improve the diagnosis of HCC patients would be an appropriate approach to evaluate new drugs or treatment modalities. To answer all the open questions, further trials, possibly randomized, should be conducted on a substantial number of patients with homogeneous prognostic factors.

Antibiotics, Antineoplastic↗

Arterial mapping with color flow duplex imaging of the lower extremities after excimer-laser-assisted angioplasty.

The purpose of the present study was to evaluate the role of color flow duplex imaging (CFDI) in the follow-up of patients who have undergone excimer-laser-assisted angioplasty of peripheral arteries. Sixty-one patients (40 men and 21 women) were studied (mean age +/- SD sixty-three +/- nine years). All patients were affected by peripheral vascular disease and, for this reason, underwent percutaneous excimer-laser-assisted angioplasty. Digital angiography and CFDI were performed before the laser procedure. CFDI was repeated at months 1, 3, 6, 9, and 12 after the laser procedure, whereas angiography was repeated after twelve months. Common, superficial, and profunda femoral arteries and popliteal arteries were visualized in looking for the presence of lesions and occlusions, and spectral analysis of Doppler signals was recorded. After the initial success, claudication was reported again by 9 patients, 7 of whom showed total occlusions. All reocclusions were discovered by CFDI and confirmed by angiography; 3 of these 7 patients underwent a second laser procedure. The remaining 2 symptomatic patients showed patent vessels and did not undergo angiography. Another 9 patients redeveloped an occlusion, unsuspected from clinical history and symptoms. All the reocclusions, confirmed by angiography, were diagnosed by CFDI. The data show that CFDI provides an accurate noninvasive technique for following up patients after excimer laser angioplasty, allowing for asymptomatic reocclusions to be recognized and treated if necessary, and permitting symptoms not due to reocclusions to be properly identified, thus avoiding unnecessary angiography.

Aged↗

[Adrenal cystic lymphangioma. A case report].

Adrenal cysts are uncommon. A case of left adrenal cystic lymphangioma in 16 year old boy is reported. The adrenal cyst was a chance finding during radiological investigation for abdominal pain. Ultrasound and CT scan showed the cyst and suggested the correct diagnosis of cystic lymphangioma of the left adrenal gland. The patient underwent surgery and a left adrenalectomy was performed. Histology confirmed the previous diagnosis of cystic lymphangioma.

Adolescent↗

Acute venous thrombosis of spleno-mesenteric portal axis: an unusual localization of thromboembolism in the nephrotic syndrome.

The nephrotic syndrome has been frequently associated with thromboembolic episodes. We report the case of a patient affected by minimal change nephropathy who developed acute thrombosis of the spleno-mesenteric portal axis and partially recovered after thrombolytic and anticoagulant therapy. Unfortunately, the patient died of pulmonary embolism after suspension of the anticoagulant therapy for gastrointestinal bleeding.

Adult↗

Elastofibroma: CT and MR findings.

Two cases of elastofibroma of the chest wall are reported. Each patient was investigated with CT and, in 1 case, MR imaging was also performed. Elastofibroma appears like a mass in the subscapular region and often presents problems of differential diagnosis. The contribution of MR imaging is reported.

Adult↗

[Pleural fibroma: radiographic and CT findings].

Pleural fibroma is a rare and benign primary tumor, mainly asymptomatic and of big size due to its slow growth from visceral pleura. Six patients (5 males and 1 female) with this pathologic condition were studied; the tumors had diameters ranging 2.5-18 cm. The diagnosis was occasional in 4 patients, while the extant presented with dyspnea, cough, and thoracic pain. Two large fibromas originating from the left basal visceral pleura failed to be correctly diagnosed on plain films, while 2 small pedunculated lesions exhibited blurred outlines at the pleural origin. On chest films, neither rib erosions nor pleural effusions or calcifications were detected. CT scans showed 2 small lesions to have both shape and localization typical of pleural origin, while a third pedunculated fibroma mimicked an intrapulmonary mass. Three huge fibromas, especially 2 of them originating from left basal pleura, were misdiagnosed by CT and topographic criteria. CT images after intravenous injection of contrast medium showed mainly a mottled and irregular densitometric pattern. A correct diagnosis was very difficult to make also with the help of CT-guided biopsy (performed on 5 patients), because the specimens had a fibrous content and were very small due the elasticity of the mass against the needle. All patients underwent surgery and were cured when discharged. Histology was always necessary for a conclusive diagnosis to be made.

Aged↗