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Pezzullo F, Comune R, D'Avino R, Mandato Y, Liguori C, Lassandro G, Tamburro F, Galluzzo M, Scaglione M, Tamburrini S. CT prognostic signs of postoperative complications in emergency surgery for acute obstructive colonic cancer. Radiol Med 2024; 129:525-535. [PMID: 38512630 DOI: 10.1007/s11547-024-01778-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/04/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE To identify CT prognostic signs of poor outcomes in acute obstructive colonic cancer (AOCC). METHODS Demographic, clinical, laboratory, radiological and surgical data of 65 consecutive patients with AOCC who underwent emergency surgery were analyzed. CT exams were reviewed to assess diameters of cecum, ascending, transverse, descending, and sigmoid proximal to the tumor; colon segments' CD/L1-VD ratios, continence of the ileocecal valve, small bowel overdistension, presence of small bowel feces sign and cecal pneumatosis. Post Operative complications (PO), according to the Clavien-Dindo classification, were analyzed. RESULTS Gender, age and location of the tumor were not predictive factors of complications. Among laboratory exams, CRP was the most important predictive value of PO (OR 8.23). A cecum distension ≥ 9 cm represented the critical diameter beyond which perforation and cecal necrosis were found at surgery. Cecal pneumatosis at CT was correlated with cecal necrosis at surgery in < 50% of patients. Pre-operative transverse colon CD/L1-VD ratio ≥ 1.43 and descending colon CD/L1-VD ratio ≥ 1.31 were associated with the development of PO (grade ≥ III-V). PO (grade ≥ III-V) occurred in 18/65 patients. CONCLUSION Postoperative complications in emergency surgery of AOCC were not related to the age, sex and tumor's location. Preoperative PCR values (≥ 2.17) predict the development of postoperative complications. CT resulted a valid diagnostic tool to identify patients at higher risk of complications: a CD/L1-VD ratios with cut-off values of 1.43 (transverse) and 1.31 (descending) predicted major complications (grade ≥ III-V) and a cecum distension ≥ 9 cm represented the critical diameter beyond which perforation occurred in > 84% of patients.
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Affiliation(s)
- Filomena Pezzullo
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Rosita Comune
- Division of Radiology, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Italy
| | - Raffaelle D'Avino
- Department of Surgery, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Ylenia Mandato
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Carlo Liguori
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Giulia Lassandro
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Fabio Tamburro
- Department of Radiology, Ospedale del Mare, ASL NA1 Centro, Naples, Italy
| | - Michele Galluzzo
- Department of Emergency Radiology, San Camillo Forlanini Hospital, Rome, Italy
| | - Mariano Scaglione
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Piazza Università, Sassari, Italy
- Department of Radiology, James Cook University Hospital, Middlesbrough, UK
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Mandato Y, Pecoraro C, Gagliardi G, Tecame M. Azygos and hemiazygos continuation: An occasional finding in emergency department. Radiol Case Rep 2019; 14:1063-1068. [PMID: 31320962 PMCID: PMC6612666 DOI: 10.1016/j.radcr.2019.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 07/09/2018] [Accepted: 07/16/2018] [Indexed: 02/06/2023] Open
Abstract
Interruption of the inferior vena cava (IVC) with azygos continuation is a rare congenital anomaly, in which the IVC is interrupted below the hepatic vein and venous return beyond this point is restored by the dilated azygos and hemiazygos veins draining into the superior vena cava. A case of the interruption of the IVC with azygos/emyazygos continuation for the absence of the hepatic segment of IVC, left renal vein duplication, and polysplenia is reported. The embryologic, clinical, and radiological significance are discussed. The diagnosis is suggested by X-ray, but contrast-enhanced multidetector computed tomography is the method of choice to diagnose this venous anomaly and reveals the aberrant vascular structures. Awareness of different congenital anomalies of IVC is important to surgeons and cardiologists and is necessary for radiologists to avoid diagnostic pitfalls and for preoperative planning: they should be remembered because they can influence several surgical interventions and endovascular procedures. Accidental ligation of the azygos vein is fatal and cardiac catheterization using the lower extremity vein is troublesome in patients with this condition.
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Affiliation(s)
- Ylenia Mandato
- U.O.C. di Diagnostica per Immagini, Ospedale Evangelico Fondazione Betania di Napoli, Napoli, Italy
| | - Cesira Pecoraro
- U.O.C. di Diagnostica per Immagini, Ospedale Evangelico Fondazione Betania di Napoli, Napoli, Italy
| | - Giuliano Gagliardi
- Dipartimento Medico-Chirurgico di Internistica Clinica e Sperimentale "F. Magrassi - A. Lanzara," Università degli Studi della Campania "Luigi Vanvitelli," Napoli, Italy
| | - Mario Tecame
- Dipartimento Medico-Chirurgico di Internistica Clinica e Sperimentale "F. Magrassi - A. Lanzara," Università degli Studi della Campania "Luigi Vanvitelli," Napoli, Italy
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Rossi C, Reginelli A, D'Amora M, Di Grezia G, Mandato Y, D'Andrea A, Brunese L, Grassi R, Rotondi A. Safety profile and protocol prevention of adverse reactions to uroangiographic contrast media in diagnostic imaging. J BIOL REG HOMEOS AG 2014; 28:155-165. [PMID: 24750802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The purpose of the study is to examine the incidence of adverse reactions caused by non-ionic contrast media in selected patients after desensitization treatment and to evaluate the safety profile of organ iodine contrast media (i.c.m.) in a multistep prevention protocol. In a population of 2000 patients that had received a CT scan, 100 patients with moderate/high risk for adverse reactions against iodinated contrast agents followed a premedication protocol and all adverse reactions are reported and classified as mild, moderate or severe. 1.7 percent of the pre-treated patients reported a mild, immediate type reaction to iodine contrast; of these five patients with allergy 0.71 percent had received iomeprol, 0.35 percent received ioversol and 0.71 percent received iopromide. The incidence of adverse reactions was reported to be higher (4 out of 5 patients) among those that referred a history of hypersensitivity against iodinated i.c.m. Although intravenous contrast materials have greatly improved, especially in terms of their safety profile, they should not be administered if there isn't a clear or justified indication. In conclusion, even if we know that the majority of these reactions are idiosyncratic and unpredictable we propose, with the aim of improving our knowledge on this subject, a multicenter study, based on skin allergy tests (prick test, patch test, intradermal reaction) in selected patients that have had previous experiences of hypersensitivity against parenteral organ iodine contrast media.
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Affiliation(s)
- C Rossi
- 1Second University of Naples, Department of Experimental and Clinical Internistic F. Magrassi A. Lanzara, Diagnostic Imaging Section, Naples, Italy
| | - A Reginelli
- 1Second University of Naples, Department of Experimental and Clinical Internistic F. Magrassi A. Lanzara, Diagnostic Imaging Section, Naples, Italy
| | - M D'Amora
- 1Second University of Naples, Department of Experimental and Clinical Internistic F. Magrassi A. Lanzara, Diagnostic Imaging Section, Naples, Italy
| | - G Di Grezia
- 1Second University of Naples, Department of Experimental and Clinical Internistic F. Magrassi A. Lanzara, Diagnostic Imaging Section, Naples, Italy
| | - Y Mandato
- 1Second University of Naples, Department of Experimental and Clinical Internistic F. Magrassi A. Lanzara, Diagnostic Imaging Section, Naples, Italy
| | - A D'Andrea
- S.G. Moscati Hospital, Radiology Department, Aversa, Italy
| | - L Brunese
- University of Molise, Department of Health Science, Campobasso, Italy
| | - R Grassi
- 1Second University of Naples, Department of Experimental and Clinical Internistic F. Magrassi A. Lanzara, Diagnostic Imaging Section, Naples, Italy
| | - A Rotondi
- 1Second University of Naples, Department of Experimental and Clinical Internistic F. Magrassi A. Lanzara, Diagnostic Imaging Section, Naples, Italy
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Fusco R, Filice S, Granata V, Mandato Y, Porto A, D’Aiuto M, Rinaldo M, Bonito MD, Sansone M, Sansone C, Rotondo A, Petrillo AP. Can semi-quantitative evaluation of uncertain (type II) time-intensity curves improve diagnosis in breast DCE-MRI? ACTA ACUST UNITED AC 2013. [DOI: 10.4236/jbise.2013.63a052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Reginelli A, Mandato Y, Solazzo A, Berritto D, Iacobellis F, Grassi R. Errors in the radiological evaluation of the alimentary tract: part II. Semin Ultrasound CT MR 2012; 33:308-17. [PMID: 22824121 DOI: 10.1053/j.sult.2012.01.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Plain abdominal radiography and computed tomographic (CT) enteroclysis are 2 essential radiological investigations in the study of gastrointestinal tract. Errors in patient preparation, execution, and interpretation may lead to severe consequences in the diagnosis and thus in patient outcome. Abdominal radiography is one of the most frequently requested radiographic examinations, and has an established role in the assessment of the acute abdomen. CT enteroclysis has revolutionized the assessment of small-bowel pathology, especially in patients with inflammatory bowel. The purpose of this article is to describe the pitfalls in the execution and interpretation of plain abdominal film and CT enteroclysis.
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Affiliation(s)
- Alfonso Reginelli
- Department of Internal and Experimental Medicine, Magrassi-Lanzara, Institute of Radiology, Second University of Naples, Naples, Italy.
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Mandato Y, Reginelli A, Galasso R, Iacobellis F, Berritto D, Cappabianca S. Errors in the Radiological Evaluation of the Alimentary Tract: Part I. Semin Ultrasound CT MR 2012; 33:300-7. [DOI: 10.1053/j.sult.2012.01.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Reginelli A, Mandato Y, Cavaliere C, Pizza NL, Russo A, Cappabianca S, Brunese L, Rotondo A, Grassi R. Three-dimensional anal endosonography in depicting anal-canal anatomy. Radiol Med 2012; 117:759-71. [PMID: 22228126 DOI: 10.1007/s11547-011-0768-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Accepted: 05/25/2011] [Indexed: 01/17/2023]
Abstract
PURPOSE This report describes the advantages of 3D anal endosonography in depicting the normal anatomy of the anal canal in relation to sex and age. MATERIALS AND METHODS A retrospective study was performed of 85 patients, 33 men and 52 women, previously examined with 3D anal ultrasound (US) for clinically suspected anorectal disease but found to be negative. The examinations were performed with a Bruel and Kjaer US system with a 2050 transducer, scanning from the anorectal junction to the subcutaneous portion of the external anal sphincter (EAS). The 3D reconstructions provided an estimation of sphincter length in the anterior and posterior planes, and axial 2D images enabled calculation of the thickness of the internal anal sphincter (IAS) and EAS in the anterior, posterior and lateral transverse planes. RESULTS Distribution of the sphincter complex is asymmetric in both sexes: the EAS and IAS are significantly shorter in females, especially in the anterior longitudinal plane (p=0.005 and p<0.001, respectively). EAS and IAS thickness increases with age, especially the lateral IAS (R(2)=0.37, p<0.001) and the posterior EAS (R(2)=0.29, p=0.01). CONCLUSIONS A good knowledge of anal-canal anatomy is essential to detect sphincter abnormalities when assessing pelvic floor dysfunction.
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Affiliation(s)
- A Reginelli
- Dipartimento di Internistica Clinica e Sperimentale F. Magrassi e A. Lanzara, Sezione di Radiodiagnostica, Seconda Università degli Studi di Napoli, P.zza Miraglia 2, 80138, Napoli, Italy
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Catalano O, Voit C, Sandomenico F, Mandato Y, Petrillo M, Franco R, Botti G, Caracò C, Mozzillo N, D'Errico AG. Previously reported sonographic appearances of regional melanoma metastases are not likely due to necrosis. J Ultrasound Med 2011; 30:1041-1049. [PMID: 21795479 DOI: 10.7863/jum.2011.30.8.1041] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES Sonography has proven to be a reliable tool in early detection of lymph node and in-transit cutaneous-subcutaneous metastases. Those metastases normally appear as hypoechoic or even anechoic lesions on sonography. It has been assumed that this appearance is due to necrosis of the lesions, but so far, that assumption has never been proven. The purpose of this retrospective study was to evaluate whether the hypoechoic appearance of melanoma metastasis is really due to tumor necrosis. METHODS From a radiographic database, we retrieved 212 melanoma cases imaged with sonography over a 2-year period for disease staging or follow-up. We selected 37 positive cases with 84 nodal and extranodal (satellite and in-transit) metastatic lesions and reviewed the sonograms and pathologic slides (slides available for 40 of 84 lesions). We retrospectively assessed the vascularization pattern (color Doppler images available for 78 of 84 lesions), categorizing it as poor, intermediate, or consistent. We also looked for necrosis on the histopathologic material, categorizing it into scores of 0, 1, 2, and 3 for absence of necrosis, less than 20% necrosis, 20% to 40% necrosis, and greater than 40% necrosis, respectively. RESULTS Despite their gray scale appearance, most melanoma lesions were vascularized on color Doppler imaging and showed limited necrosis at histopathologic analysis. Consistent vascularization on Doppler imaging, excluding substantial necrosis, was found in 44 of 78 lesions (56.4%). Poor vascularization on Doppler imaging, suggesting necrosis, was present in only 14% of the lesions. Substantial necrosis (scores of 2 and 3) was found pathologically in only 10% of the lesions. CONCLUSIONS Necrosis seems to be an uncommon event in melanoma metastasis and is probably not the basis for its low-level echo pattern on sonography. The hypoechoic appearance is very typical of melanoma metastasis and is likely due to massive melanomatous infiltration (with the poor echo reflectivity of melanin). However, confirmation in larger pathologically proven series is required.
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Affiliation(s)
- Orlando Catalano
- Department of Radiology, National Cancer Institute, Fondazione G. Pascale, via Semmola, 80131 Naples, Italy.
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Reginelli A, Mandato Y, Russo A, Iacobellis F, Cappabianca S, Brunese L, Grassi R. Morphological rectal alterations following STARR performed for obstructed defecation syndrome. BMC Geriatr 2011. [PMCID: PMC3194380 DOI: 10.1186/1471-2318-11-s1-a51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Cappabianca S, Granata V, Di Grezia G, Mandato Y, Reginelli A, Di Mizio V, Grassi R, Rotondo A. The role of nasoenteric intubation in the MR study of patients with Crohn's disease: our experience and literature review. Radiol Med 2010; 116:389-406. [PMID: 20981501 DOI: 10.1007/s11547-010-0605-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 02/15/2010] [Indexed: 02/08/2023]
Abstract
PURPOSE The aim of this study was to compare magnetic resonance (MR) enteroclysis with MR enterography to verify whether nasoenteric intubation in patients affected by Crohn's disease can provide supplementary information to that afforded by MR study of the small bowel. MATERIALS AND METHODS In a 12-month period, 40 patients (28 women and 12 men, mean age 35 years) affected by Crohn's disease underwent MR imaging. Distension of the small-bowel loops was obtained by administering polyethylene glycol: 15 patients were given the mixture by mouth (MR enterography), whereas the remaining 25 received it via nasoenteric intubation (MR enteroclysis). Our study protocol included morphological sequences taken before and after intravenous injection of contrast medium and real-time functional sequences. Accuracy criteria for the execution of the examinations were designed according to 11 bands. RESULTS Complete distension of the small-bowel loops was obtained in the 25 patients who underwent MR enteroclysis, with the additional advantage of a suitable assessment of those segments involved in the pathological process. This was not the case for the 15 patients who underwent MR enterography, because both the jejunum and the small-bowel loops appeared partially collapsed. CONCLUSIONS MR enteroclysis is the most effective technique for studying the small bowel in Crohn's disease, as it not only provides a suitable morphological assessment but also supplies functional information.
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Affiliation(s)
- S Cappabianca
- Dipartimento di Internistica clinica e sperimentale Magrassi-Lanzara, Sezione di Radiodiagnostica e Radioterapia, Seconda Università degli Studi di Napoli, P.zza Miraglia 2, 80138, Napoli, Italy
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