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Biomedical subjects

S Fabiano

Publications and source records attributed to S Fabiano.

9 recordsLinked to original sources
PubMed2005

The EpiLink record linkage software: presentation and results of linkage test on cancer registry files.

OBJECTIVES: Record linkage, the process of bringing together separately compiled but related records from different databases, is essential in many areas of biomedical research. We developed a record linkage program (EpiLink), which employs a simple mathematical approach. We describe the program and present results obtained testing it in a linkage task. METHODS: EpiLink was designed to be flexible with user-friendly settings to tailor linkage and operating parameters to specific linkage tasks, and employ deterministic, probabilistic or sequential deterministic-probabilistic linkage strategies as required. The user can also standardize data format, examine linkage results and accept or discard them. We used EpiLink to link a subset of cases of the Lombardy Cancer Registry (20,724 records) with the Social Security file of the population (1,021,846 records) covered by the registry. The linkage strategy was deterministic, followed by several probabilistic linkage steps. RESULTS: Manual inspection of the results showed that EpiLink achieved 98.8% specificity and 96.5% sensitivity. CONCLUSIONS: EpiLink is a practical and accurate means of linking records from different databases that can be used by non-statisticians and is efficient in terms of human and financial resources.

Humans↗
PubMed1999

MRI of the biliary and pancreatic ducts.

Magnetic resonance Cholangiopancreatography (MRCP) is a non-invasive imaging technique able to provide projectional images of the bile ducts. Different sequences, using both breath-hold and non-breath-hold acquisition techniques, have been employed in order to obtain MRCP images. The authors discuss technical aspects, considering both three-dimensional non-breath-hold techniques and two-dimensional breath-hold, multi-slice and thick slab sequences. Clinical applications of MRCP are evaluated, presenting data from both the literature and personal experience. The main indication for MRCP study is represented by the evaluation of common bile duct obstruction, with the aim of assessing the presence of the obstruction (accuracy 85-100%) and, subsequently, its level (accuracy 91-100%) and its cause. The utility of associating conventional MR images to MRCP in malignant strictures, in order to characterize and stage the malignant lesion, is also discussed. Finally, data are presented regarding the indications and the utility of MR-pancreatography in the evaluation of patients with pancreatic duct anomalies and chronic pancreatitis.

Bile Duct Diseases↗
PubMed1999

[Magnetic resonance imaging and magnetic resonance cholangiopancreatography in evaluation of chronic pancreatitis. Part I: techniques and methods].

Until recently, MR examinations of the pancreas were limited by motion artifacts, vascular pulsatility and poor spatial resolution. Today, new techniques have been developed, which allow to overcome these problems and provide additional information such as selective images of biliary and pancreatic ducts and vascular structures. MR examinations of the pancreas need to include either breath-hold or nonbreath-hold morphological T1- and T2-weighted images; a contrast agent is required when the study is performed with fast imaging which allow the acquisition of dynamic images in arterial and portal venous phases. Recently, a new liver-specific contrast agent (Mn-DPDP) has been demonstrated to provide selective pancreatic enhancement. As a complement to baseline sequences, MR cholangiopancreatography images can be acquired, possibly integrated by functional examination after secretin administration. Finally, contrast-enhanced MR angiography opens new perspectives for vascular studies, particularly for the locoregional staging of pancreatic cancer.

Cholangiography↗
PubMedDate not supplied

Management of biliary neoplastic obstruction with two different metallic stents implanted in one session.

The efficacy of the "one-step" technique using two different metallic stents (Wallstent and Ultraflex) and associated rate of complications was studied in 87 patients with jaundice secondary to malignant biliary obstruction, with bilirubin level less than 15 mg/dl and Bismuth type 1 or 2 strictures. The study group, composed of 40 men and 47 women with a mean age of 59.4 years (range 37-81 years), was treated with a "one-step" percutaneous transhepatic implantation of self-expanding stents. The cause of the obstruction was pancreatic carcinoma in 38 patients (44%), lymph node metastasis in 20 patients (23%), gallbladder carcinoma in 13 patients (15%), cholangiocarcinoma in 12 patients (14%) and ampullary carcinoma in four patients (5%). A significant reduction in jaundice was obtained in all but one patient, with a drop of total serum bilirubin level from a mean of 13.7 mg/dl to 4.3 mg/dl within the first 4 days. The mean postprocedural hospitalization period was 5.4 days in the Wallstent group and 6.4 days in the Ultraflex group. Mean survival rate was 7.8 months (Wallstent group) and 7.1 months (Ultraflex group). The use of both stents did not reveal any significant difference in parameters tested. The implantation of these self-expandable stents in one session, in selected patients, is clinically effective, devoid of important complications and cost-effective due to the reduction in hospitalization.

Adult↗
PubMedDate not supplied

Bilateral renal artery aneurysm: percutaneous treatment with stent-graft placement.

A 51-year-old man with an 8-year history of hypertension (170/115 mmHg with two drugs) and altered renal function (5.6 mg/dl serum creatinine, 101 mg/dl BUN) was referred to our Department to evaluate the renal arteries and rule out renovascular hypertension. Doppler ultrasound and magnetic resonance angiography revealed significant bilateral renal artery stenosis and the presence of bilateral renal artery aneurysms. A self-expandable polytetrafluoroethylene (PTFE)-covered nitinol stent-graft was deployed in each renal artery to treat the stenoses and to exclude the aneurysm. Postprocedural digital subtraction angiography confirmed the resolution of the renal artery stenoses and the complete exclusion of the aneurysms. At the 6 month follow-up, color Doppler confirmed normal patency of the renal arteries with complete exclusion of the aneurysms and significant reduction of the blood pressure (130/85 mmHg with one drug) and serum creatinine levels (2.1 mg/dl).

Aneurysm↗
PubMedDate not supplied

[MR imaging of pancreatic neoplasms].

The role of MR imaging in the assessment of pancreatic adenocarcinoma is in identification, characterization and staging of the neoplastic lesion. Technique optimization is required in order to obtain high qualities images competitive with spiral CT. The choice of imaging protocol is strictly related to the available equipment as well as fast imaging capabilities. Contrast-enhanced study using breath-hold sequences is required if working at high field strength with high gradient performance; on mid-low field strength nonbreath-hold acquisition techniques, using respiratory compensation techniques, can be implemented. The use of fat saturation pulses may increase the sensitivity of MR in detecting pancreatic lesions. Other advantages of MR imaging are represented by the availability of additional noninvasive techniques for the evaluation of the biliary tree (MR-cholangiopancreatography) and splanchnic vessels (MR-angiography). Lesion identification is based on TIw sequences where the lesion appears hypointense compared with the surrounding pancreas; increased lesion-pancreas contrast is obtained when fat suppression is used. On dynamic studies following gadolinium injection, pancreatic tumors are hypovascular compared with surrounding normal pancreatic gland. Problems in correctly defining the size of the lesions may be encountered in patients presenting with inflammatory changes of the pancreatic parenchyma surrounding the carcinoma (epineoplastic pancreatitis). For lesion characterization MRI is not able to characterize focal pancreatic lesions, allowing a differential diagnosis between pancreatic cancer and focal hypertrophic chronic pancreatitis. Even the use of MR-cholangiopancreatography is not helpful for characterizing focal pancreatic masses. MR imaging is accurate in local staging (assessment of peripancreatic fat infiltration) thanks to the higher contrast resolution, but in vascular staging and in the evaluation of lymphnodal involvement it suffers the same limitations as computed tomography. Future perspective are represented by the use of magnetic resonance angiography for the evaluation of vascular encasement and the use of specific contrast agents for lymphadenopathy. Identification of hepatic metastases with MRI has been proven to be high, with sensitivity and specificity comparable to CT. The use of liver-specific contrast agents (either positive or negative) is becoming almost routine and it is proving to further improve the diagnostic value of MRI.

Adenocarcinoma↗
PubMedDate not supplied

Multidetector row CT coronary angiography: technique and preliminary experience.

PURPOSE: To report our preliminary experience with multi-slice spiral CT coronary angiography of the coronary arteries. MATERIALS AND METHODS: 50 volunteers (mean age 61 years, range 45-72) with baseline heart rates below 70 bpm underwent multi-detector row CT coronary angiography (GE Light Speed Plus, 140 kVp, 270 mA, 1.25-mm collimation, 0.5-second rotation time, high quality pitch) with retrospective ECG gating after receiving 140-150 ml of iodinated contrast medium (Iopamiro 300 mg-dl, Bracco, Italy) at a flow rate of 4 ml/sec. Three of the 50 patients had previously undergone coronary procedures (1 anterior descending artery stent, 1 left circumflex artery stent and 1 anterior descending artery percutaneous angioplasty) and three were undergoing follow-up examinations after by-pass surgery. The remaining 44 patients were asymptomatic and had no history of coronary artery disease. All CT angiograms were back-reconstructed from 20 to 80% of the diastolic cycle with 10% increments to establish the phase with fewer "stair-step" motion artefacts for each artery. Patients with heart rates above 70 bpm were administered beta-blockers during the five days preceding the examination in doses appropriate for the patient's clinical characteristics. RESULTS: The CT room occupation time ranged from 25 to 35 minutes (mean time 27') and the post-processing time from 30 to 60 minutes (mean time 40'). The left anterior descending artery was best visualised in middle diastole (70% of cardiac cycle), the circumflex artery at 60% of the cardiac cycle, and the right coronary artery at 40%. Out of 132 arteries, 19 (14.4%) were considered non-assessable due to "stair-step" motion artefacts, whereas 2 (1.5%) were only partially visualised owing to the presence of extensive wall calcifications. Among the 113 assessable arteries, we observed: 72 normal coronary arteries without stenosis or wall calcifications (54.5%); 28 arteries with minimal wall irregularities and stenoses below 50% (21.2%); 7 stenoses >50% involving the right coronary artery (no. 2), the anterior descending arteries (no. 4) and the left circumflex artery (no. 1) (5.3%). In the remaining 6 patients, optimal visualisation of the stents and venous and arterial surgical by-passes was obtained. CONCLUSIONS: Although further larger-scale studies are required to compare MSCT coronary angiography with CT coronary angiography, the application of MSCT technology to the study of the coronary arteries is a promising technique with a good potential for use in routine clinical practice. In selected patients (with baseline heart rates <70 bpm, or after beta-blocker therapy) it is able to provide very interesting results and could be used as a method of choice for following patients after interventional procedures or as a mass-screening tool to select patients to be referred for coronary angiography.

Aged↗