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P Mannella

Publications and source records attributed to P Mannella.

At least 19 recordsLinked to original sources
PubMed1998

Extracorporeal lithotripsy of intrahepatic stones with associated strictures of intrahepatic biliary ducts.

BACKGROUND AND AIMS: Intrahepatic stones are a frequent disease in the Eastern world but rare in Western countries. Treatment is complex and often requires surgical intervention. Extracorporeal shock wave lithotripsy is a relatively recent technique, widely used in the treatment of stones in the gallbladder and common bile duct. It can also be used in the treatment of intrahepatic stones. The present study analyses the efficacy of extracorporeal shock wave lithotripsy in intrahepatic stones. PATIENTS AND METHODS: In our study, we used extracorporeal lithotripsy in six cases of intrahepatic stones (mean age 53 years). In five of these cases deformities of the intrahepatic bile ducts were also present: stenoses and angulated strictures. The stones were in the right lobe of the liver in 5 patients, and in both lobes in 1 patient. Four patients had multiple stones and 2 a single stone, all varying in diameter from 6 to 25 mm. The stones were localized radiologically with contrast medium through a drainage tube. The technique does not require anaesthesia. An average of three lithotripsy sessions were necessary, with a mean total of 8050 shock waves per patient. RESULTS: Successful fragmentation was obtained in 5 out of 6 patients, while the remaining subsequently underwent surgery. No complications were observed. CONCLUSIONS: Extracorporeal shock wave lithotripsy proved to be effective, easy to perform and safe for the treatment of intrahepatic stones.

Adult↗
PubMed1996

[Diagnostic impact of ultrasonography in abdominal diseases].

The diagnostic accuracy of conventional radiography and ultrasound (US) in patients with acute or chronic abdominal pain was investigated by the authors in two prospective studies to assess the capabilities of the two imaging techniques. 262 patients (135 men and 127 women, age range: 25-83 years) were entered into the study within 8 months. The patients were divided into different groups according to clinical presentation (80 patients with acute and 182 with chronic pain) and to the referring physician (a hospital clinician for 127 patients and a general practitioner for 135 patients). For each technique the presence (positive result) or the absence (negative result) of abnormal imaging features related to clinical symptoms was recorded and the agreement of conventional radiography and US findings was assessed. Statistical analysis showed similar sensitivity of conventional radiography and US in the examination of acute hospitalized patients (54.3% positive results), chronic hospitalized patients (28.1% negative results) and chronic nonhospitalized patients (47.2% negative results). The results of our prospective studies showed poor diagnostic accuracy of the two techniques and clearly evidenced the improper use of diagnostic imaging methods by referring physicians, with a technical-oriented attitude in imaging examination requests. In the authors' opinion, a clinical-based approach by referring physicians with accurate patient selection might improve diagnostic accuracy, the cost/benefit ratio and the clinical effectiveness of imaging techniques.

Abdominal Pain↗
PubMed1995

[The role of muscle scintigraphy with 201Tl in the morphofunctional assessment of obliterative arterial pathology of the lower limbs].

This study was aimed at assessing the role of stress 201Tl leg scintigraphy, compared with digital angiography, in the diagnosis and prognosis of peripheral arterial obstructive disease (PAOD) before and after surgical treatment. Fifty-four patients with known PAOD in Fontaine stages IIb, III or IV submitted to revascularization (36) or lumbar ganglionectomy (18), were examined with both angiography and scintigraphy. A statistical analysis of 360 segments (thighs and calves) was performed; in particular, correlation values were derived from 216 preoperative and 144 postoperative segments (18 patients who underwent lumbar ganglionectomy were not submitted to postoperative angiography). Scintigraphy vs. angiography sensitivity (84%), specificity (80%) and diagnostic accuracy (90%) values obtained in this study are in agreement with those reported in international literature. Scintigraphy yields information on the locoregional perfusion of an angiography-demonstrated anatomic lesion, under physiologic stress, which is particularly useful in symptomatic patients with angiographically unimportant stenoses. At present, 201Tl leg scintigraphy is the only technique yielding semiquantitative data in the assessment of single muscle groups perfusion increase in Fontaine IV patients submitted to lumbar ganglionectomy. The original contribution of this study consists in the evidence of a high predictive value (p < 0.01) of scintigraphy in the calculation of pain-free intervals in the patients with successful revascularization at clinics and angiography. This finding, if confirmed, shows a possible role for 201Tl leg scintigraphy in the diagnosis of peripheral arterial obstructive disease.

Aged↗
PubMed1995

[Comparative evaluation of ultrasonography, computerized tomography, angiography and lipiodol CT in defining extent of hepatocarcinoma. A multicenter study].

The authors report the results of a multicentric trial on hepatocellular carcinoma (HCC) patients, whose lesions were confirmed with biopsy or by high (> 400 ng/ml) alpha-fetoprotein levels. The series consisted of 149 patients examined in 8 different centers and submitted to ultrasonography (US), Computed Tomography (CT) before and after contrast agent administration, angiography and Lipiodol CT. According to lesion size and number, the patients were divided with each imaging modality into three groups: a) group 1: unifocal HCC < 5 cm diameter; b) group 2: multifocal HCC with 2-3 nodules and/or tumor mass < 80 ml; c) multifocal HCC with more than 3 nodules (with total tumor mass not exceeding 40% of liver volume) or with total tumor mass > 80 ml. In 77 patients all the examinations were available for comparison. US and CT diagnosed more patients as belonging to group 1 than angiography and Lipiodol CT, while more patients were classified as groups 2 and 3 with angiography and Lipiodol CT, meaning that US and CT may understage some HCC cases (about 15%) because they show a lower number of nodules. This observation was confirmed by the direct comparison between US and Lipiodol CT (in 114 patients), CT and Lipiodol CT (in 103 patients) and angiography and Lipiodol CT (in 116 patients). US and Lipiodol CT were in disagreement in 18 cases, CT and Lipiodol CT in 16 cases and angiography and Lipiodol CT in 13 cases. In most of these cases, Lipiodol CT showed more lesions than the other techniques. The size of the undetected lesions was small, ranging few mm to 2 cm in nearly all cases. To conclude, the results of this multicentric trial show that Lipiodol CT is a fundamental tool to evaluate HCC extent. In contrast, conventional CT appeared not to add any significant piece of information and can therefore be excluded from the diagnostic protocol of HCC.

Angiography↗
PubMed1994

[Homogenized thoracic radiography].

The major obstacle to optimal radiographic depiction of the chest has always been its anatomical features and, in particular, the considerable difference in X-ray beam attenuation between pulmonary and mediastinal structures. At least 40% of this region cannot be visualized in an optimal way. Therefore, much technological work was done to overcome this limitation, which has recently led to the development of electronic (Amber) and mechanical (homogenization) filtration systems. This study was aimed at assessing the capabilities of mechanical filtration, in terms of anatomical representation and lower biologic cost, the latter intended as lower exposure and absorbed doses. Therefore, eight radiologists studied 40 negative radiographs, i.e., a homogenized radiograph and a non-homogenized one per patient, twenty patients in all. The statistical analysis of the radiographs demonstrated the homogenized technique to allow better visualization of all the anatomical structures examined, i.e., trachea, carina, right and left main bronchi, aorta, spine and retrocardiac region. In contrast, the two radiographic techniques yielded much the same results in the depiction of the pulmonary pattern. As for dosimetry, good results were also obtained, because the homogenizer made it possible to reduce both exposure and absorbed doses to the lung and thyroid, while in the mediastinal region the absorbed dose remained similar to that measured with the non-homogenized even though exposure dose was increased mildly.

Humans↗
PubMed1993

[Palliative treatment of esophageal neoplastic stenoses with self-expanding metallic stents].

Thirty Strecker nickel-titanium self-expanding metallic stents were implanted in 20 patients with esophageal strictures and inoperable neoplasms in the Departments of Radiology of the University School of Medicine of Ferrara, Genoa, Novara and Rome, from March 1992 to April 1993; follow-up ranged 1 to 13 months. Thanks to the stents, esophageal strictures could be dilated, significantly reducing dysphagia and allowing the patients to return on to a solid diet. Radiological and endoscopic exams proved the efficacy of the stents in all but 2 patients in whom the tumors had invaded the stent lumen and caused obstruction. In all cases the stents were highly biocompatible and well tolerated. Neither major complications, such as perforation or bleeding, were observed, nor minor ones, such as fever or migration from the site of implant, which may occur with plastic prostheses. To conclude, self-expanding metallic stents used in clinical trials for 13 months proved an effective method in the palliative treatment of malignant esophageal strictures.

Aged↗
PubMed1993

[Ultrasonographic semiology of biliary prostheses].

US was used to study 60 patients with different types of plastic (Home-made, Lunderquist, Miller, Carey-Coons, Lammer) and metallic (Z-stent, Wallstent) biliary stents, from October 1990 to March 1993. The optimal US approach was assessed, together with several US features which are typical of each type of endoprosthesis. As far as plastic endoprostheses are concerned, independent of manufacturing differences, the typical US pattern on longitudinal scans is a hyperechoic double line while, on transverse scans, the prosthesis cylinder is represented by short hyperechoic lines, resembling the mathematic equal sign. According to the different types, metallic stents appear as thin hyperechoic lines or narrow gratings on longitudinal scans and as hyperechoic spots following a circular pattern or as a hyperechoic ring on transverse scans.

Bile Ducts↗
PubMed1992

Effectiveness of partial splenic embolization as treatment for hypersplenism in thalassaemia major: a 7-year follow up.

Partial splenic embolization is an alternative procedure to total splenectomy in patients with hypersplenism, and was performed in 10 patients with beta-thalassaemia major who were then followed for 5 to 7 years. The results were compared with those of a 7-yr follow-up of 6 splenectomized thalassaemics. The blood consumption decreased and the leucocyte counts increased in both groups of patients. However, after partial splenic embolization, severe thrombocytosis--which is typical of splenectomized patients--did not develop and there were no severe complications from the operation, such as infections or reappearance of hypersplenism. In addition, the minor surgical injury and avoidance of abdominal scars were further advantages of partial splenic embolization over total splenectomy.

Adolescent↗
PubMed1992

[Computerized tomography follow-up after percutaneous renal lithotripsy].

Even though extracorporeal shock wave lithotripsy (ESWL) is nowadays considered the treatment of choice for the majority of upper urinary tract calculi, percutaneous stone removal will continue to be an alternative treatment method in selected cases. Therefore, percutaneous techniques must not be forgotten by the interventional radiologist. In order to assess the effects and the potential damage caused by this interventional procedure to kidney and perirenal tissues, CT was performed on 20 patients before and after percutaneous nephrolithotripsy. In the cases where no complications occurred during the maneuver, post-nephrolithotripsy scans demonstrated low incidence of significant renal abnormalities. Thickening of pararenal fascia (8 patients) and irregular renal outline (10 patients) were our most frequent findings. In 5 patients we found edema of the pyelo-ureteral junction, in 3 thickening of the bridging perinephric septa and retained stone fragments, in 2 perirenal hematomas, in one a subcapsular fluid collection. Urinoma with pelvic laceration was demonstrated in the only patient in whom the maneuver presented marked technical problems. On the basis of this series of pre- and post-nephrolithotripsy CT scans of treated kidneys, the authors conclude that this percutaneous technique is quite atraumatic.

Adult↗
PubMed1989

[Postoperative biliary calculosis: our experience with therapeutic strategy].

The Authors report their experience in the treatment of 92 cases of post-surgical biliary tract stones: 17 early cases (18.5%) were treated by percutaneous nonsurgical extraction (10 cases) or by operative procedures (7 cases); 75 late cases (81.5%) were surgically treated. The Authors summarize the results of the treatment, discussing advantages and disadvantages of the various techniques.

Cholangiography↗
PubMed1989

[Advantages of a light-equipped angiographic guide in percutaneous obliteration of the spermatic veins].

Percutaneous transvenous treatment has become the elective therapy for varicocele because it is a simple, safe, economic and reliable procedure. The presence of proximal anastomoses connecting a competent valved spermatic trunk with the renal vein can be responsible for a varicocele and make its treatment difficult. In such cases; the valve of the spermatic venous trunk can be bypassed using an open-ended guidewire with a removable mandril core, and then injecting the sclerosing agent through the guide. Moreover, the guidewire can facilitate the insertion of the catheter through the competent valve, thus allowing the placement of Gianturco coils. During the past 12 months we have successfully treated 4 patients affected by varicocele with competent valved venous trunk using the open-ended guidewire.

Embolization, Therapeutic↗
PubMed1989

[Percutaneous subtotal splenic embolization in thalassemia major. A 4-year follow up].

Ten young patients affected with thalassemia major with hypersplenism were treated with subtotal percutaneous embolization. Percutaneous procedure was used to correct hypersplenism, while preserving a small portion of splenic parenchyma. Embolization was successful in 9 patients, and no significant complications were observed; in 1 patient arterial catheterization and splenic embolization were not possible due to splenic artery tortuosity. Post-procedural clinical course was characterized by intense pain, not always reduced by therapy. Hospitalization time was similar to that of surgical splenectomy. Effectiveness of percutaneous embolization was evaluated with splenic scintigraphy, clearance of erythrocytes marked with 99mTc and denatured with BMHP and with the analysis, both before and after percutaneous procedure, of the following 3 parameters: annual blood consumption, behavior of pre-transfusional hemoglobin, and transfusional pause. Six patients underwent a 4-year follow-up. In all cases scintigraphy showed the effectiveness of subtotal embolization, and clearance of erythrocytes appeared slower than before. As for clinics, an improvement was observed in transfusional parameters. The results from our series, though numerically limited, support the role of percutaneous splenic embolization as an alternative to surgical splenectomy in high risk patients or in patients who refuse surgery.

Adolescent↗
PubMed1988

[Percutaneous therapy of primary varicocele. 6 years' experience].

Idiopathic varicocele is nowadays accepted as a "social disease" for both its high incidence among young men and its affecting male fertility. Screening is thus required for young people and, above all, early and definitive treatment. We have evaluated the effectiveness of percutaneous sclerotherapy, which has become a standard procedure, in spite of its recent introduction in interventional radiology. One hundred and thirty-nine percutaneous occlusions were performed on 147 patients with varicocele using a sclerosing agent--polidocanol--and stainless steel coils. The failure rate of percutaneous treatment was about 12%. Complications never required hospitalization or surgery; recurrence rate is 3.66%. The patients were followed 3, 6, 12 and 24 months by US and Doppler to survey recurrences, and sperm analysis to estimate the clinical results of percutaneous therapy in infertile patients. Statistical analysis with linear regression of data from spermiograms showed constant improvement in sperm count, sperm motility percentage, and sperm morphology percentage. Fertility index improvement was similar to that of surgical ligation. The radiation dose received by the patient is negligible. Percutaneous therapy represent thus the treatment of choice in case of varicocele: compared with surgery, it offers similar clinical results and a lower recurrence rate, and it can be performed on an outpatient basis. Surgery should be performed only when anatomic variants make percutaneous treatment not feasible.

Adolescent↗
PubMed1988

[Percutaneous nephrostomy. A 5-year experience].

The authors report their experience with percutaneous nephrostomy in the treatment of acute renal failure due to ureteral obstruction. One hundred and forty-three patients were treated with the positioning of 218 percutaneous nephrostomy catheters under fluoroscopic guidance. If performed as soon as possible, this percutaneous diversion provides a rapid improvement in renal function and allows an accurate staging of the lesion, as well as correct therapeutic indications. In many cases of urinary obstruction interventional radiology procedures represent a valid and successful alternative to more invasive palliative surgery.

Acute Kidney Injury↗
PubMed1988

[Personnel exposure in intraoperative biliary radiology].

The diffusion of percutaneous procedures under fluoroscopic guidance has raised the question of excessive radiation exposure to the patient and to the interventional radiology personnel. In order to give an answer to this question we prospectively evaluated the radiation doses received by the operator's hands, lens, thyroid, and gonads during 243 percutaneous cholangiographies and transhepatic biliary drainages. The absorbed dose was measured with calibrated lithium fluoride thermoluminescent dosimeters applied to the skin (hands, neck, forehead, and gonads). The range of absorbed doses to the four areas was: from 0.013 to 0.219 mGy for the hands, from 0.011 to 0.027 mGy for the thyroid, from 0.007 to 0.019 mGy for the lens; the gonads dose was not measurable due to the dosimeter being placed behind the lead apron. The radiation dose employed during our biliary interventional procedures is higher than that of selective visceral angiography, but lower than that of PTA. On the basis of our data, a radiologist could perform about 2777 PTCs, or 1718 percutaneous biliary drainages, per annum, without exceeding the ICRP dose limits.

Bile↗