Biomedical subjects

Roberto Fiori

Publications and source records attributed to Roberto Fiori.

7 recordsLinked to original sources

PubMed2004

Kyphoplasty: a new opportunity for rehabilitation of neurologic disabilities.

Using percutaneous kyphoplasty, we treated a patient with a diagnosis of Guillain-Barré syndrome who complained of an unremitting pain in the spine, refractory to the conventional medical therapy, elicited by pressure over the spinous process, and in absence of neurologic deficits. The method provided swift midline back pain relief associated with an evident augmentation in the stability and in the vertebral body's height. The injection of polymethylmethacrylate was effective and safe, no cement leakages were observed, and no complications such as pulmonary embolism, toxicity, or infection were observed. Due to the rapid pain relief, a rehabilitation program was promptly undertaken with a good improvement of the disability score (FIM scale score). Kyphoplasty is a new method for treatment of vertebral collapses consequent to osteoporosis, aggressive hemangiomas, myelomas, and metastases, and it may aid in rehabilitation of the underlying systemic neurologic disorder if the pain is interfering with those therapies.

Aged↗

PubMed2003

Virtual colonoscopy compared with conventional colonoscopy for stricturing postoperative recurrence in Crohn's disease.

BACKGROUND: The place of virtual colonoscopy (VC) in patients with Crohn's disease (CD) requiring endoscopic follow-up after surgery is unknown. The authors compared findings from VC versus conventional colonoscopy (CC) for assessing the postoperative recurrence of CD. METHODS: Sixteen patients with ileocolonic anastomosis for CD were prospectively enrolled from January 2001 to January 2002. Recurrence was assessed by CC according to Rutgeerts et al. VC was performed with a computed tomography scanner, with images examined by three radiologists who were unaware of the endoscopic findings. RESULTS: CC showed perianastomotic recurrence in 15 of 16 patients. Perianastomotic narrowing or stenosis was detected by VC in 11 of these 15 patients. There were 11 true positive, 1 true negative, 0 false-positive, and 4 false-negative findings (73% sensitivity, 100% specificity, 100% positive predictive value, 20% negative predictive value, 75% accuracy). Among the eight patients showing a rigid stenosis of the anastomosis not allowing passage of the colonoscope, VC detected narrowing or stenosis in seven patients. CONCLUSIONS: The current findings suggest that although the widespread use of VC in CD is currently not indicated because of possible false-negative findings, this technique may represent an alternative to CC in noncompliant postsurgical patients with a rigid stenosis not allowing passage of the endoscope.

Adult↗

PubMedDate not supplied

Percutaneous kyphoplasty: indications and technique in the treatment of vertebral fractures from myeloma.

AIMS AND BACKGROUND: The purpose of our research was to assess the effectiveness and safety of percutaneous kyphoplasty, the new method of treatment for pain deriving from vertebral compression fractures due to myeloma. METHODS: We treated 3 patients with pain refractory to conventional medical therapy (analgesics, bed-rest, bracing with orthopedic devices for more than 4 weeks), localized in the lumbar area, painful to the touch and in the absence of neurological signs. RESULTS: The method demonstrated a swift pain relief associated with an evident augmentation in the resistance and restoration of the vertebral body's physiological shape. Polymethylmethacrylate leaks were not observed in the epidural or foraminal area, nor were complications such as pulmonary embolism for involvement of the venous plexus or related to phenomenon of infections due to the procedure, or toxicity due to the polymethylmethacrylate. CONCLUSIONS: Kyphoplasty was found to be an effective alternative, simple and safe in the treatment of vertebral collapse consequent to multiple myeloma. The same injection of polymethylmethacrylate can be done before the radiotherapy treatment, thereby synergizing its delayed analgesic action to pain, or after the failure or in the case of local recurrence.

Fractures, Spontaneous↗

PubMedDate not supplied

Percutaneous kyphoplasty: new treatment for painful vertebral body fractures.

AIMS AND BACKGROUND: The purpose of this study was to assess the effectiveness and safety of Percutaneous Kyphoplasty as a new method of treatment for pain deriving from vertebral compression fractures (VCF). PATIENTS AND METHODS: We treated sixteen patients with unremitting pain over spine, which increased particularly when pressure was applied over the spinous process, in absence of neurological signs and refractory to conventional medical therapy. RESULTS: The method demonstrated swift pain relief associated with an evident augmentation in the resistance and restoration of the vertebral body's physiological shape. Polymethylmethacrylate (PMMA) leakages were not observed in the epidural space or foraminal area. The presence of complications such as pulmonary embolism involving the venous plexus, toxicity due to PMMA and infection due the procedure did not occur. CONCLUSION: Kyphoplasty is an effective, alternative, simple and safe treatment of vertebral collapse consequent to osteoporosis. aggressive haemangiomas, myelomas and metastases.

Aged↗

PubMedDate not supplied

Radiofrequency Heat Ablation and Vertebroplasty in the treatment of neoplastic vertebral body fractures.

BACKGROUND: Metastatic cancer is the most common malignant disease of the skeletal system. Traditionally, conventional fractionated external beam radiotherapy has been the treatment of choice. Recently, minimally invasive surgical techniques (MISS) have been added to the therapeutic armamentarium. The purpose of our study was to assess the effectiveness and safety of Radiofrequency Heat Ablation and Vertebroplasty in the treatment of neoplastic Vertebral Compressive Fractures (VCF). The aim of radiofrequency heat ablation is to destroy the tumor tissue before stabilizing the vertebra through the intrasomatic injection of cement. PATIENTS AND METHODS: We treated patients with unremitting pain over spine, in absence of symptomatic spinal cord or roots compression and refractory to conventional therapeutic options such as radiation therapy, chemotherapy, surgery and use of analgesics. RESULTS: The method demonstrated swift pain relief associated with an evident augmentation in the weight-bearing resistance. CONCLUSION: The association of Radiofrequency Heat Ablation and Vertebroplasty is an effective, simple and safe treatment of vertebral collapse consequent to metastases.

Aged↗

PubMedDate not supplied

Kyphoplasty: indications, contraindications and technique.

PURPOSE: Percutaneous Kyphoplasty is an emerging Interventional Radiology technique consisting in injecting polymethylmethacrylate (PMMA) into collapsed vertebral bodies under fluoroscopic guidance, after compaction of the cancellous bone with two dedicated balloon catheters. The purpose of our study was to assess the indications, contraindications, technique and results of our initial study. MATERIALS AND METHODS: Between January and May 2003 we treated 11 patients (5 men, 6 women) with vertebral collapse occurred up to three months earlier and due to osteoporosis or myeloma (mean age: 68.9), with pain refractory to medical therapy. All patients underwent treatment on a single vertebra (1 D7; 1 D8; 2 D12; 3 L1; 3 L2; 1 L4). Patient selection was based on clinical and instrumental criteria: conventional radiography, CT and MR were performed on all patients before the procedure. The Visual Analogue Scale (VAS) for pain assessment was used to evaluate the post-procedure results. RESULTS: All patients showed an increase in the height of the collapsed vertebral body, associated with partial or complete pain relief (VAS score decreasing from a pre-treatment score of 8 to a score of 2 after treatment). No complications related to the procedure were recorded. CONCLUSIONS: The indications for kyphoplasty include recent vertebral compression fractures due to osteoporosis, myeloma, metastasis and vertebral angioma with intractable pain and with no neurological symptoms. The main contraindications are coagulation disorders, unstable fractures or complete vertebral collapse (vertebra plana). Kyphoplasty proved to be a safe and effective method for the treatment of intractable pain due to vertebral collapse that allows for shorter hospital stays and an immediate improvement in the patient's quality of life.

Aged↗

PubMedDate not supplied

MRI and bone scan imaging in the preoperative evaluation of painful vertebral fractures treated with vertebroplasty and kyphoplasty.

BACKGROUND: This study compared the role and timing of bone scintigraphy and magnetic resonance imaging (MRI) in the evaluation of vertebral compression fractures (VCFs), before treatment with vertebroplasty and kyphoplasty. To our knowledge, no prior articles have described, in osteoporotic and pathological vertebral fractures, the role of MRI and bone scintigraphy as pre-procedural work up in those patients candidated to undergo spinal interventional procedures. MATERIALS AND METHODS: A retrospective chart review was performed of thirty patients treated with interventional procedures for painful vertebral fractures at our institution between January 2002 and July 2003. RESULTS: In patients, selected after evaluation with MRI and bone scan imaging, both procedures demonstrated swift pain relief associated with vertebral resistance augmentation. CONCLUSION: MRI revealed itself to be equivalent to bone scan imaging in selecting patients to be treated with vertebroplasty and kyphoplasty in the first 3/4 months, while bone scintigraphy was more accurate in the evaluation of elderly fractures (> 3/4 months). MRI was superior to bone scintigraphy in vertebral collapses due to multiple myeloma.

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