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T Livraghi

Publications and source records attributed to T Livraghi.

At least 55 records · Page 3Linked to original sources
PubMed1992

Percutaneous ethanol injection in the treatment of hepatocellular carcinoma in cirrhosis. A study on 207 patients.

In 207 cirrhotic patient carriers of hepatocellular carcinoma (HCC), percutaneous ethanol injection (PEI) was administered with ultrasound guidance. The patients were classified as Child's Class A, 136; B, 54; and C, 17. Their mean age was 63.5 years, and the male-female ratio was 3.5:1. There was a single HCC less than 5 cm in diameter in 162 patients; 45 had more than one HCC. The follow-up ranged from 5 to 71 months (mean, 25 months). No noteworthy complications occurred during or after 2485 treatments. The 1-year, 2-year, and 3-year survival percentages (by the Kaplan-Meier method) for the patients with one HCC were 90%, 80%, and 63%, respectively. The corresponding percentages by Child's class were 97%, 92%, and 76% for Class A; 88%, 68%, and 42% for B; and 40%, 0%, and 0% for C. The 1-year, 2-year and 3-year survival rates for patients with more than one HCC were 90%, 67%, and 31% respectively. These results were similar to those found by others and showed that PEI was a safe, reproducible, easy-to-do, and low-cost therapeutic technique. In terms of survival, these PEI results were better than the published results of no treatment and equivalent to those of surgery. In uncontrolled series, bias can play an important role. Therefore, additional trials would be useful.

Aged↗
PubMed1992

Percutaneous intranodular ethanol injection: a new treatment for autonomous thyroid adenoma.

Established methods for definitive ablation of autonomous thyroid nodules are surgery and radioiodine. Since it has been demonstrated that percutaneous ethanol injection can inactivate parathyroid adenomas and small hepatocellular carcinomas, we started a trial of this treatment in patients with autonomous thyroid nodules. Twenty-eight patients, 22 toxic and 6 nontoxic, all with undetectable thyrotropin serum levels and suppressed extranodular tissue on scintigraphy, were treated. Treatment consisted of percutaneous intranodular ethanol injection under ultrasound guidance. The total amount of alcohol injected ranged from 0.4 to 2.2 times the estimated nodule volume, divided into 4 to 9 injections performed at 2 to 7 day intervals. Most patients were treated with a single cycle of injections, but 7 of them required 2 cycles. The signs and symptoms of hyperthyroidism disappeared in all cases. Apparently complete cure (normal serum free thyroid hormones, thyrotropin in basal conditions and after thyrotropin releasing hormone, reactivation of extranodular tissue on scintigraphy with nodule no longer visible) was obtained in 17 patients (13 after 1 cycle and 4 after 2 cycles). Partial cure (normal serum free thyroid hormone levels, detectable thyrotropin levels with normal or blunted response to thyrotropin releasing hormone and partial reactivation of extranodular tissue on scintigraphy with nodule or parts of it still visible) was obtained in 10 patients (8 after 1 cycle and 2 after 2 cycles). In 1 patient with a very large nodule thyrotropin levels remained undetectable, but thyroid hormone levels eventually became normal. No recurrences were observed after a follow-up of 12 to 32 months (mean 20 months). No serious side effects were encountered. A clinically valuable result was obtained in all patients. These data suggest that this form of treatment could constitute an alternative to surgery and radioiodine for the ablation of autonomous thyroid nodules.

Adenoma↗
PubMed1992

Percutaneous ethanol injection of hepatocellular carcinoma: survival after 3 years in 70 patients.

Percutaneous ethanol injection (PEI) under ultrasound control is a new therapeutic procedure for cirrhotic patients with small hepatocellular carcinoma (HCC). Our experience included 70 patients with 110 lesions (range 0.8-5 cm). Follow-up ranged from 5 to 70 months (mean: 25 months). No serious complications occurred after 930 treatments. The 1, 2, 3-year survival rates (Kaplan-Meier method) were: 96, 84, 72% for single lesions less than 5 cm and 94, 84, 25% for multiple lesions. In our opinion and in consideration of the results of other authors obtained with PEI and with surgery, single lesions less than 5 cm found in Child's A and B patients with high surgical risk or with some adverse prognostic factors for surgery, could be an indication for PEI.

Adult↗
PubMed1991

Hypoechoic lesions in fatty liver. Quantitative study by histomorphometry.

Ten patients with fatty liver changes were subjected to liver biopsies. In seven, ultrasonography showed focal hypoechogenicity within a "bright" liver, generally interpreted as focal sparing. Three patients had hyperechoic areas surrounded by "normal" parenchyma usually felt to represent local fat accumulation without diffuse involvement. Morphometric analysis was used to determine the total area occupied by fat (area density) and the number of lipid droplets (numerical density) per microscopic field in lesional and perilesional specimens. Compared with respective perilesional values, hypoechoic lesional numerical densities were significantly lower in 6 of 7 patients; the three hyperechoic samples had significantly higher values. In most cases, lesional and perilesional area densities were not significantly different. These hypoechoic focal lesions are believed to be merely areas in which a similar quantity of fat is contained in fewer droplets, and focal hyperechogenicity is believed to result from a larger number of fat-filled vacuoles with respect to that of the surrounding parenchyma. Variation in the number of solid-liquid interfaces causes the ultrasonic contrast between these lesions and the similarity fatty liver parenchyma surrounding them.

Biopsy, Needle↗
PubMed1991

Liver metastases: results of percutaneous ethanol injection in 14 patients.

Percutaneous ethanol injection (PEI) was performed under ultrasound (US) guidance in the outpatient department in 14 patients with 21 metastases 1.0-3.8 cm in diameter. The primary cancer was colorectal adenocarcinoma (seven patients), adenocarcinoma of the stomach (four patients), abdominal leiomyosarcoma (one patient), gastrinoma of unknown origin (one patient), and bronchial carcinoid (one patient). The indicators of therapeutic efficacy were US, computed tomography, fine-needle biopsy, and serologic markers. No complications occurred after a total of 175 treatment sessions. Complete response was obtained in 11 lesions, nine of which were less than 2 cm in diameter, and in all endocrine metastases (four lesions in two patients) with a maximum, recurrence-free follow-up of 38 months. Carcinoembryonic antigen values decreased in all patients but one for a 2-6-month period. The natural course of metastatic disease strictly limits the applicability of PEI, a local treatment. Single, metachronous, nonoperable metastasis of adenocarcinoma and endocrine metastases seem to be the only indications for PEI.

Adolescent↗
PubMed1991

Small hepatocellular carcinoma treated with percutaneous ethanol injection: MR imaging findings.

Fifty-seven magnetic resonance (MR) imaging examinations were obtained at 0.5 T in 19 patients before and after percutaneous ethanol injection (PEI) for 23 hepatocellular carcinoma (HCC) lesions less than 3.5 cm in diameter. Seventeen patients also underwent MR imaging 6 months after completion of therapy. In 11 patients, computed tomography was performed before and after treatment. After PEI, fine-needle biopsy specimens were obtained in all cases. Before treatment, HCC lesions had low signal intensity on T1-weighted images in 13 cases, had the same signal intensity as normal liver parenchyma in six, and had high signal intensity in four; all 23 tumors had high signal intensity on T2-weighted images. After treatment and at 6-month follow-up, all 21 lesions that contained no malignant cells at fine-needle biopsy had high signal intensity on T1-weighted images and had low signal intensity on T2-weighted images. The remaining two HCC lesions in which tumor necrosis was not achieved with PEI displayed a different MR pattern, since the residual neoplastic tissue showed no change in signal intensity on either T1- or T2-weighted images. The authors conclude that MR imaging may be useful for evaluating the effectiveness of PEI in achieving tumor regression.

Aged↗
PubMed1990

Percutaneous alcohol injection of portal thrombosis in hepatocellular carcinoma: a new possible treatment.

Hepatocellular carcinoma (HCC) with portal thrombosis is usually regarded as a contraindication for surgery and for percutaneous alcohol injection (PAI). For palliative purposes we used PAI in 4 patients with infiltrative HCC and segmental portal thrombosis. Ethanol, injected directly into the thrombus, diffused mostly along it. No complications emerged after 20 injections. In the first patient, who later received a liver transplant, the thrombus was completely necrotic. In the other patients, biopsies yielded only necrotic material: in two cases, progression of the thrombus was stopped at 4 and 12 months of follow-up, and in one case the thrombus shrank and remained as such 13 months later. This preliminary experience might broaden the scope of treatment for HCC.

Carcinoma, Hepatocellular↗
PubMed1990

Ultrasound-guided fine-needle biopsy of focal liver lesions: techniques, diagnostic accuracy and complications. A retrospective study on 2091 biopsies.

Two thousand and ninety-one ultrasound-guided fine-needle biopsies were performed in 1946 patients to diagnose focal liver lesions. The diagnostic accuracy of fine-needle biopsies is very high (only one false positive was observed), both for aspiration biopsy (93.4%) and for cutting biopsy (95.1%). The difference is not statistically significant. In cases of hepatocellular carcinoma (but not in cases of metastasis or hepatic lymphoma), double biopsy (aspiration and cutting) showed higher diagnostic sensitivity than single methods. A certain number of benign focal liver lesions were also diagnosed. In the present series, no case of death following liver puncture was observed. Intraperitoneal hemorrhage was the most common complication. The risk with a cutting needle being higher than with an aspirative needle.

Biopsy, Needle↗
PubMed1990

Treatment of autonomous thyroid nodules with percutaneous ethanol injection: preliminary results. Work in progress.

Eight patients with autonomous thyroid nodules 2.4-4.3 cm in diameter received percutaneous ethanol injections (PEIs) under guidance by means of ultrasound (US). Sterile ethanol at 95% was injected with a 22-gauge needle and a 7.5-MHz probe with a guide device. Each patient received one or two treatments, with 1-3 mL of alcohol (depending on the nodule size) per treatment, each week for a total of three to six injections per lesion. After a total of 36 injections in all eight patients, there were no complications. Follow-up ranged from 2 to 10 months. After therapy, symptoms subsided and hormonal levels became normal or reached the range of subclinical hypothyroidism. Scintigrams showed that the previously suppressed thyroid tissue had resumed functioning. At US, all nodules had shrunk. PEI was risk free and easy to perform. If these preliminary results are confirmed in a larger study with longer follow-up, the new treatment may become an alternative to surgical or radioiodine ablation of autonomous thyroid nodules.

Adult↗
PubMed1989

Fine needle biopsy of hepatocellular carcinoma: improvement in diagnosis by microhistology.

Percutaneous liver biopsies with fine aspirating and cutting needles were performed under ultrasound guidance to diagnose hepatocellular carcinoma in 112 cases. All the specimens were examined partially with cytologic methods and partially with microhistology. Cytology established the diagnosis of hepatocellular carcinoma in 83 cases and of generic malignancy in 12, with 9 false-negatives and 8 inadequates. Microhistology established the diagnosis of hepatocellular carcinoma in 92 case and of generic malignancy in 2, with 3 false-negatives and 15 inadequates. In all, the combined retrieval rate was 98% with only 2 cases of inadequate material and the diagnosis of hepatocellular carcinoma was possible in 105 cases (93.7%).

Adult↗
PubMed1989

Adenomatous hyperplastic nodules in the cirrhotic liver: a therapeutic approach. Work in progress.

Adenomatous hyperplastic nodules (AHNs) in the cirrhotic liver may be precurosors of hepatocellular carcinoma. These nodules have been demonstrated more frequently because of the increased use of ultrasonography (US) in the screening of high-risk patients. Treatment is a problem because surgical resection of a precancerous lesion is considered by some to be unadvisable in patients with high surgical risk. The authors used percutaneous ethanol injection with US guidance in five patients with AHNs that measured 1.4-2.6 cm. A total of 30 injections were performed, without complications. Lesions were undetectable or were reduced in size on follow-up US scans. All biopsies yielded necrotic material. No recurrences have been demonstrated with US after 9-21 months. Percutaneous ethanol injection is therefore proposed as a therapeutic alternative for small AHNs.

Adenoma↗
PubMed1988

Fine aspiration versus fine cutting needle, and comparison between smear cytology, inclusion cytology and microhistology in abdominal lesions.

Two hundred patients underwent ultrasound guided percutaneous fine needle biopsy of focal solid abdominal lesions using 22 gauge aspiration and cutting needles. The material obtained by aspiration needle was treated by smear cytology and by inclusion cytology, and that obtained by cutting needle by microhistology. The retrieval rate was 89% for aspiration needle (smear cytology = 89%, inclusion cytology = 83.5%) and was 83% for cutting needle; the combined diagnostic accuracy was 98%. The typing accuracy was 76% for smear cytology, and was 84% for inclusion cytology and microhistology. We conclude that: 1. to obtain the highest retrieval rate (98%) both aspiration and cutting needles are necessary, because the aspiration needle is more likely to secure necrotic or soft tissue, and the cutting needle, fibrous or hard tissue; 2. histologic treatment of the samples yields a higher typing accuracy: 84% vs 76%; however, smear cytology remains essential because it permits a much faster evaluation of the adequacy of the sample and because it may avoid histologic methods in 76% of cases; 3. the smear cytology + microhistology combination seems to be the best solution (retrieval rate = 97.5%), but the costs are much higher because the cutting needle is somewhat expensive. The best solution would be to use the combination smear + inclusion cytology (retrieval rate = 89%) and to reserve the cutting needle for when aspiration needle material proves to be inadequate.

Abdominal Neoplasms↗
PubMed1988

Small hepatocellular carcinoma: percutaneous alcohol injection--results in 23 patients.

Twenty-three patients with hepatocellular carcinoma less than 4.5 cm in diameter (32 lesions) were treated with a percutaneous injection of ethyl alcohol performed with ultrasound (US) guidance. No complications or sequelae occurred after 271 treatments. All lesions were smaller after 6-27 months follow-up. No evidence of hepatocellular carcinoma was present at fine-needle biopsy or contrast material-enhanced computed tomography (CT). No viable tumor cells were detected in four patients who subsequently underwent surgery. The 1-year survival rate of 12 patients was 91.7%. From these data, it can be concluded that percutaneous alcohol injection (PAI) is an appropriate first-line treatment for patients with small hepatocellular carcinoma lesions who are poor surgical risks. Given the risk of new nodular lesions occurring on resected livers and the risk of perioperative mortality, PAI might even be considered an alternative to surgery.

Aged↗
PubMed1987

240 hepatocellular carcinomas: ultrasound features, tumor size, cytologic and histologic patterns, serum alpha-fetoprotein and HBs Ag.

Two hundred and forty cases of hepatocellular carcinomas (HCC), diagnosed by ultrasonography and fine needle biopsy, were studied. The following parameters were investigated: 1. echo features (240 cases) - hypoechoic, 54; hyperechoic, 56; complex, 112; isoechoic with halo, 18; 2. tumor size (240 cases) - single tumor under 4.5 cm, 30; single tumor over 4.5 cm, 74; multiple masses or diffuse, 136; 3. cytologic pattern (240 cases) - well and medium differentiated, 144; pleomorphic, 43; poorly differentiated, 28; unclassified, 25; 4. histologic pattern (157 cases) - trabecular, 74; solid, 42; acinar, 1; mixed, 2; unclassified, 38; 5. alpha-fetoprotein (AFP) level (185 cases) - under 20 ng/ml, 79; between 20 and 320 ng/ml, 40; over 320 ng/ml, 66; 6. HBs Ag (208 cases) - present in 56 cases; 7. cirrhosis (102 cases) - present in 79 cases. Some of the above parameters were correlated with one another. There was: 1. a highly significant frequency of the hypoechoic feature among small HCC; 2. a percentage of AFP-producing tumors increasing with tumor size; 3. no relationship between AFP production and cytologic or histologic pattern; 4. no relationship between tumor size and cytologic or histologic pattern. However, among the small HCC, all the 9 HCC with a diameter of less than 3 cm showed a trabecular pattern and well-differentiated cells. Cirrhosis was present in every patient with a small HCC. Since the discovery of a small HCC is an incidental ultrasonographic finding in the context of severe liver disease, ultrasonographic monitoring of cirrhotic patients is the best available strategy to screen for small HCC.

Adult↗
PubMed1986

Percutaneous interstitial chemotherapy of a small hepatocellular carcinoma under ultrasound guidance.

A small (less than 3 cm) inoperable hepatocellular carcinoma was treated with percutaneous interstitial chemotherapy (PIC). 5-Fluorouracil was injected by a fine needle under ultrasound guidance. After 3 months a fine needle biopsy (FNB) yielded fibronecrotic material. After 18 months another FNB yielded steatosis and dysplastic cells and the lesion showed no increase in size. PIC could be an interesting alternative treatment for small tumors unresponsive to conventional therapies.

Administration, Cutaneous↗
PubMed1986

Fine needle percutaneous intratumoral chemotherapy under ultrasound guidance: a feasibility study.

To test the feasibility of fine needle (22 gauge) percutaneous intratumoral chemotherapy (PIC) under ultrasound guidance, a trial was conducted on 12 selected neoplastic patients with tumors not responsive to conventional treatments (5 adenocarcinomas of the pancreas, 1 hepatocellular carcinoma, 1 squamous cell carcinoma of the lung, 1 leiomyosarcoma of the hepatic hilum, 1 malignant fibrous histiocytoma of the ischiatic region, 2 liver and 1 peritoneal metastases). The drugs used were 5-fluorouracil, methotrexate and cyclophosphamide, according to the histotype. The doses given never exceeded the routine intravenous doses; 119 sessions of PIC were administered. There have been no significant local complications due to needle injury and drug toxicity or biochemical changes attributable to general toxicity. Partial or total pain control and stable disease or response to 60% was observed. This research has not been described previously to our knowledge.

Adenocarcinoma↗
PubMed1986

Fine-needle aspiration biopsy of bowel lesions under ultrasound guidance: indications and results.

Twenty-four patients with bowel lesions that could be imaged on a sonogram underwent ultrasound-guided fine-needle aspiration biopsy. Indications for biopsy included: poor condition of the patient precluding the use of barium studies and/or endoscopy (9 cases) or hindering technically adequate examinations (3); nonspecific radiographic images (6); inability to obtain an adequate biopsy sample during endoscopy (6). The results of biopsy were correct in the 18 cases proven by surgery or autopsy; in the remaining 6 patients, histologic results were considered conclusive, and were later confirmed by clinical, radiographic, and ultrasound follow-up. Fine-needle aspiration biopsy may be considered a simple, rapid, and accurate diagnostic procedure when an alternative approach to the study of gastrointestinal tract lesions is needed.

Adenocarcinoma↗