1
|
Crimì F, Lacognata C, Cecchin D, Zucchetta P, Pomerri F. Rectal cancer staging: An up-to-date pictorial review. J Med Imaging Radiat Oncol 2018; 62:512-519. [PMID: 29974675 DOI: 10.1111/1754-9485.12759] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 05/29/2018] [Indexed: 11/29/2022]
Abstract
Colorectal cancer is the third most common malignancy worldwide, and rectal cancer (RC) accounts for 29% of all cases. Local staging of RC is crucial for the purposes of addressing patients appropriately to surgery alone or to preoperative chemoradiotherapy (pCRT) followed by total mesorectal excision (TME). Combined pCRT and TME may negatively affect rectal function, so rectum-sparing approaches such as transanal local excision have been proposed as an alternative to TME for patients showing a major or complete clinical response on restaging after pCRT. Magnetic resonance imaging (MRI) has a fundamental role in the local staging and restaging of RC, with or without positron emission tomography (PET). PET/MRI enables a multiplanar high-resolution morphological study of the pelvis, providing important information on cell density and metabolic activity with diffusion-weighted imaging (DWI) and 18 F fluorodeoxyglucose uptake respectively. This article offers a pictorial review of the MRI anatomy of the ano-rectal region and an update on local RC staging with a hybrid 18 F-FDG PET/MRI scan.
Collapse
Affiliation(s)
- Filippo Crimì
- Radiology Unit, Department of Medicine-DIMED, University Hospital of Padova, Padova, Italy
| | | | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine-DIMED, University Hospital of Padova, Padova, Italy
| | - Pietro Zucchetta
- Nuclear Medicine Unit, Department of Medicine-DIMED, University Hospital of Padova, Padova, Italy
| | - Fabio Pomerri
- Radiology Unit, Department of Medicine-DIMED, University Hospital of Padova, Padova, Italy
| |
Collapse
|
2
|
Bilora F, Pietrogrande F, Petrobelli F, Potato G, Pomerri F, Muzzio PC. Is Radiation a Risk Factor for Atherosclerosis? An Echo-Color Doppler Study on Hodgkin and Non-Hodgkin Patients. Tumori 2018. [DOI: 10.1177/030089160609200406] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background The aim of the present paper was to study the role of irradiation in the atherosclerotic process in patients affected by Hodgkin and non-Hodgkin lymphoma. Methods We studied 84 subjects, 42 with Hodgkin or non-Hodgkin disease and 42 controls. All 42 cases had been irradiated and were comparable in terms of risk factors for atherosclerosis. All 84 subjects underwent echo-color Doppler of the arterial axis (carotids, abdominal aorta, and femoral arteries), and the intima-media thickness was measured. Results The irradiated cases had a greater intima-media thickness in the carotid district, even after dividing them according to age and sex; males were affected more than females. The irradiated patients were at greater risk of developing cardiovascular events than the controls. Conclusions An echo-color Doppler of the carotid district is advisable in all patients who have been submitted to radiotherapy, and the patients with a significantly greater than normal intima-media thickness need a strict follow-up, and antioxidant or antiaggregant therapy should be considered.
Collapse
Affiliation(s)
- Franca Bilora
- 2nd Internal Medicine Clinic, and University of Padua and IRCCS-IOV, Padua, Italy
| | | | - Francesco Petrobelli
- 2nd Internal Medicine Clinic, and University of Padua and IRCCS-IOV, Padua, Italy
| | - Giuliana Potato
- 2nd Internal Medicine Clinic, and University of Padua and IRCCS-IOV, Padua, Italy
| | - Fabio Pomerri
- Department of Medical-Diagnostic Sciences and Special Therapies, University of Padua and IRCCS-IOV, Padua, Italy
| | - Pier Carlo Muzzio
- Department of Medical-Diagnostic Sciences and Special Therapies, University of Padua and IRCCS-IOV, Padua, Italy
| |
Collapse
|
3
|
Alfieri R, Alaggio R, Ruol A, Castoro C, Cagol M, Michieletto S, Pomerri F, Acquaviva A, Ancona E. Hepatogastric Inflammatory Pseudotumor Presumably Deriving from Prior Amebic Infection. Tumori 2018; 94:584-8. [DOI: 10.1177/030089160809400423] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Inflammatory pseudotumor is a rare entity with a clinical and radiographic presentation that is difficult to differentiate from malignancy. This is a case report of a large hepatogastric inflammatory pseudotumor that presumably developed from a prior amebic pseudocyst. Case Report A 14-year-old boy presented with increasing vomiting, epigastric pain, dysphagia, asthenia and weight loss. The clinical history included an amebic infection at the age of 2 months. Instrumental investigations revealed an 8 x 6 cm left subdiaphragmatic mass inseparable from the gastric fundus, which appeared to infiltrate the left hepatic lobe. Surgery disclosed a bulky mass adhering to the gastric fundus and left hepatic lobe that prompted total gastrectomy, resection of the second and third hepatic segments, and Roux-en-Y esophagojejunal loop anastomosis. Histology subsequently confirmed that this was a pseudocyst with a large calcified nucleus surrounded by myofibroblastic proliferation associated with a diffuse lymphoplasmacytic infiltrate affecting the gastric wall and hepatic parenchyma, hence the final diagnosis of inflammatory pseudotumor, presumably in response to a prior amebic pseudocyst. Conclusions Inflammatory pseudotumor is a rare entity that is seldom found in the stomach. The particular interest of the present case lies in the fact that it developed in the stomach and liver, presumably deriving from a previous amebic pseudocyst.
Collapse
Affiliation(s)
| | - Rita Alaggio
- Department of Medical-Diagnostic Sciences and Special Therapies
| | - Alberto Ruol
- Department of Surgery and Gastroenterology, Clinica Chirurgica 3
| | | | | | | | | | | | - Ermanno Ancona
- Department of Surgery and Gastroenterology, Clinica Chirurgica 3
| |
Collapse
|
4
|
Affiliation(s)
- Franca Bilora
- Internal Medicine Clinic, University of Padua and IRCCS-IOV, Padua, Italy
| | | | | | - Giuliana Polato
- Internal Medicine Clinic, University of Padua and IRCCS-IOV, Padua, Italy
| | - Fabio Pomerri
- Department of Medical-Diagnostic Sciences and Special Therapies, University of Padua and IRCCS-IOV, Padua, Italy
| | - Pier Carlo Muzzio
- Department of Medical-Diagnostic Sciences and Special Therapies, University of Padua and IRCCS-IOV, Padua, Italy
| |
Collapse
|
5
|
Crimì F, Guido M, Pomerri F. Hepatobiliary and Pancreatic: Hepatic nodules in a patient with familial adenomatous polyposis and colorectal adenocarcinoma. J Gastroenterol Hepatol 2018; 33:8. [PMID: 29284077 DOI: 10.1111/jgh.13972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- F Crimì
- Radiology Unit, Department of Medicine-DIMED, University of Padova, Padua, Italy
| | - M Guido
- Pathology Unit, Department of Medicine-DIMED, University of Padova, Padua, Italy
| | - F Pomerri
- Radiology Unit, Department of Medicine-DIMED, University of Padova, Padua, Italy
| |
Collapse
|
6
|
Bilora F, Adamo A, Pomerri F, Prandoni P. Failure of old and new anticoagulants to prevent ischemic stroke in high-risk atrial fibrillation: a case report. Minerva Cardioangiol 2016; 64:494-496. [PMID: 27228488] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Rivaroxaban is an oral anticoagulant that acts as a direct, competitive factor Xa inhibitor. Large randomized clinical trials have shown that, at a daily dose of 20 mg, Rivaroxaban is at least as effective as dose-adjusted warfarin for the prevention of stroke or other embolic complications in patients with nonvalvular atrial fibrillation (AF). The safety and efficacy of combining Rivaroxaban with an antiplatelet agent for secondary stroke prevention has not been established. We report the case of an elderly patient with permanent AF and coronary heart disease, who had already suffered an ischemic stroke while on warfarin treatment, and was consequently switched to treatment with an association of Rivaroxaban and Aspirin. Her CHA2DS2-VASc score was 9. The patient developed a severe recurrent disabling ischemic stroke. This case goes to show that the novel direct anticoagulants may fail to prevent recurrent stroke in patients at particularly high risk, even when associated with antiplatelet drugs.
Collapse
Affiliation(s)
- Franca Bilora
- Internal Medicine Clinic, Coagulopathy Section, Department of Cardiovascular and Thoracic Sciences, Padua University, Padua, Italy -
| | | | | | | |
Collapse
|
7
|
Roma A, Maruzzo M, Basso U, Brunello A, Zamarchi R, Bezzon E, Pomerri F, Zovato S, Opocher G, Zagonel V. First-Line sunitinib in patients with renal cell carcinoma (RCC) in von Hippel-Lindau (VHL) disease: clinical outcome and patterns of radiological response. Fam Cancer 2016; 14:309-16. [PMID: 25391617 DOI: 10.1007/s10689-014-9771-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED von Hippel-Lindau (VHL) is a rare hereditary condition caused by germline alteration of VHL gene predisposing to renal carcinoma and multiple other tumors. Since acquired dysregulation of VHL-dependent pathways is often present in patients with sporadic RCC treated with the anti-angiogenic drug sunitinib, there is a strong rationale to use the same drug in VHL patients with progressive disease in the kidneys or other sites. Our primary objective was to evaluate the activity of sunitinib in terms of progression-free survival. SECONDARY OBJECTIVES rate of radiological response, patterns of responses in different organs, treatment-related toxicities. We performed a retrospective analysis of sunitinib therapy in genetically-confirmed VHL patients treated at our Institution for multifocal or advanced RCC. From February 2007 to July 2012, 14 VHL patients started first-line sunitinib for recurrent or progressing RCC, mean age 48 years (27-71). Nine patients achieved a partial RECIST response (64.3%); responses were noted not only in renal and hepatic lesions but also in pancreatic nodules. Most lesions showed density reduction, while all CNS haemangioblastoma lesions remained stable. At a median follow-up of 37 months, six patients have progressed and three patients died, with a progression-free rate at 2 years of 71.4%. Sunitinib may therefore achieve a fairly good disease control in VHL patients. Radiological responses may be obtained not only in renal tumors but also in synchronous VHL-related lesions, especially pancreatic solid nodules whose exact nature (metastatic RCC or neuroendocrine tumor) cannot be ruled out without invasive biopsy.
Collapse
Affiliation(s)
- Anna Roma
- Medical Oncology 1 Unit, Istituto Oncologico Veneto IOV - IRCCS, Via Gattamelata 64, 35128, Padua, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Canello S, Gasparini G, Luisetto P, Di Cerbo A, Pomerri F. Bone computed tomography mineral content evaluation in chickens: effects of substances in homeopathic concentration. HOMEOPATHY 2016; 105:92-5. [PMID: 26828003 DOI: 10.1016/j.homp.2015.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 03/26/2015] [Accepted: 07/11/2015] [Indexed: 12/01/2022]
Abstract
METHODS Ninety-six cobb race chickens were equally divided in 4 groups and randomly assigned to receive a standard treatment feed + homeopathic concentrations of Symphytum (S.) officinalis (9CH), or standard treatment feed + homeopathic concentrations of Tricalcarea (4CH), or standard treatment feed + homeopathic concentrations of Calcarea (C.) carbonica (30CH) or a placebo (the same feed but without any homeopathic compound) in order to assess the ability of the homeopathic compounds to increase the concentration of calcium hydroxyapatite in the sternal spongy bone tissue. We measured the concentration of calcium hydroxyapatite in the sternal spongy bone tissue of all chickens by means of a computed tomography (CT). RESULTS 30%, 36% and 63% increase of sternum spongy-bone mineralization was observed after a 2 years period in the treatment groups with S. officinalis (9CH), Tricalcarea (4CH) (*P < 0.05) and C. carbonica (30CH) (***P < 0.001) respectively. CONCLUSION Bone mineralization is usually low in battery chickens reared in commercial poultry-sheds, creating a weakness of the whole animal supporting apparatus. Homeopathic preparations with bone-tissue tropism may improve their health quality.
Collapse
Affiliation(s)
| | | | | | - Alessandro Di Cerbo
- School of Specialization in Clinical Biochemistry, University of Chieti-Pescara, Chieti, Italy.
| | - Fabio Pomerri
- Radiology Oncology Unit, Istituto Oncologico IOV, IRCCS, Padua, Italy.
| |
Collapse
|
9
|
Bilora F, Adamo A, Pomerri F, Prandoni P. An unusual finding of massive pulmonary embolism in a patient during treatment with high-dose ibuprofen. Aging Clin Exp Res 2016; 28:167-8. [PMID: 26497827 DOI: 10.1007/s40520-015-0467-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 09/22/2015] [Indexed: 11/25/2022]
Abstract
Non-steroidal anti-inflammatory drugs have been associated with an increased risk of venous thromboembolism. We report for the first time, the case of a patient who developed massive pulmonary embolism after a long period of treatment with high doses of ibuprofen. A 65-year-old woman was admitted with severe dyspnea while on treatment with high doses of ibuprofen for diffuse spine pain due to arthrosis. A spiral computed tomography showed a massive pulmonary embolism. No other explanation for the thromboembolic disorder was found. She was successfully treated with therapeutic doses of low-molecular-weight heparin followed by rivaroxaban. Ibuprofen was discontinued and replaced by tramadol. High-dose ibuprofen is likely to have accounted for the life-threatening thromboembolic disorder.
Collapse
Affiliation(s)
- Franca Bilora
- Internal Medicine, Coagulation Section, Cardiovascular Science Department, Padua University, Via Giustiniani, 2, 35128, Padua, Italy.
| | - Angelo Adamo
- Internal Medicine, Coagulation Section, Cardiovascular Science Department, Padua University, Via Giustiniani, 2, 35128, Padua, Italy
| | - Fabio Pomerri
- Internal Medicine Department (DIMED), Radiology Institute, Padua University, Padua, Italy
| | - Paolo Prandoni
- Internal Medicine, Coagulation Section, Cardiovascular Science Department, Padua University, Via Giustiniani, 2, 35128, Padua, Italy
| |
Collapse
|
10
|
Indraccolo S, Randon G, Zulato E, Nardin M, Aliberti C, Pomerri F, Casarin A, Nicoletto MO. Metformin: a modulator of bevacizumab activity in cancer? A case report. Cancer Biol Ther 2015; 16:210-4. [PMID: 25607951 PMCID: PMC4623111 DOI: 10.1080/15384047.2014.1002366] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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] [Indexed: 11/30/2022] Open
Abstract
Recurrent type I endometrial cancer (EC) has poor prognosis and demands novel therapeutic approaches. Bevacizumab, a VEGF-A neutralizing monoclonal antibody, has shown clinical activity in this setting. To our knowledge, however, although some diabetic cancer patients treated with bevacizumab may also take metformin, whether metformin modulates response to anti-VEGF therapy has not yet been investigated. Here, we report the case of a patient with advanced EC treated, among other drugs, with bevacizumab in combination with metformin. The patient affected by relapsed EC G3 type 1, presented in march 2010 with liver, lungs and mediastinic metastases. After six cycles of paclitaxel and cisplatin she underwent partial response. Later on, she had disease progression notwithstanding administration of multiple lines of chemotherapy. In march 2013, due to brain metastases with coma, she began steroid therapy with development of secondary diabetes. At this time, administration of Bevacizumab plus Metformin improved her performance status. CT scans performed in this time window showed reduced radiologic density of the lung and mediastinic lesions and of liver disease, suggestive of increased tumor necrosis. Strong 18F-FDG uptake by PET imaging along with high levels of monocarboxylate transporter 4 and lack of liver kinase B1 expression in liver metastasis, highlighted metabolic features previously associated with response to anti-VEGF therapy and phenformin in preclinical models. However, clinical benefit was transitory and was followed by rapid and fatal disease progression. These findings—albeit limited to a single case—suggest that tumors lacking LKB1 expression and/or endowed with an highly glycolytic phenotype might develop large necrotic areas following combined treatment with metformin plus bevacizumab. As metformin is widely used among diabetes patients as well as in ongoing clinical trials in cancer patients, these results deserve further clinical investigation.
Collapse
Affiliation(s)
- Stefano Indraccolo
- a Immunology and Molecular Oncology Unit ; Istituto Oncologico Veneto-IOV-IRCCS ; Padova , Italy
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Scagliori E, Evangelista L, Panunzio A, Calabrese F, Nannini N, Polverosi R, Pomerri F. Conflicting or complementary role of computed tomography (CT) and positron emission tomography (PET)/CT in the assessment of thymic cancer and thymoma: our experience and literature review. Thorac Cancer 2015; 6:433-42. [PMID: 26273398 PMCID: PMC4511321 DOI: 10.1111/1759-7714.12197] [Citation(s) in RCA: 13] [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: 09/16/2014] [Accepted: 10/16/2014] [Indexed: 12/02/2022] Open
Abstract
Background To evaluate the role of computed tomography (CT) and positron emission tomography (PET)/CT in patients with thymic cancer and thymoma at initial staging. Methods We retrospectively reviewed CT and PET/CT scans of 26 patients with a thymic cancer (n = 9) or thymoma (n = 17). Chest CT findings documented were qualitative and quantitative. Both qualitative and semiquantitative data were recovered by PET/CT. The comparisons among histological entities, outcome, and qualitative data from CT and PET/CT were made by non-parametric analysis. Results PET/CT resulted positive in 15/17 patients with thymoma. CT was available in 5/9 (56%) patients with thymic cancer and in 3/17 with thymoma. All quantitative CT parameters were significantly higher in patients with thymic cancer than thymoma (maximum axial diameter: 45 vs. 20 mm, maximum longitudinal diameter: 69 vs. 21 mm and volume: 77.91 vs. 4.52 mL; all P < 0.05). Conversely, only metabolic tumor volume (MTV) and total lesion glycolysis were significantly different in patients with thymic cancer than thymoma (126.53 vs. 6.03 cm3 and 246.05 vs. 20.32, respectively; both P < 0.05). After a median follow-up time of 17.45 months, four recurrences of disease occurred: three in patients with thymic cancer and one with a type B2 thymoma. CT volume in patients with recurrent disease was 102.19 mL versus a median value of 62.5 mL in six disease-free patients. MTV was higher in the recurrent than disease-free patient subset (143.3 vs. 81.13 cm3), although not statistically significant (P = 0.075). Conclusion Our preliminary results demonstrated that both morphological and metabolic volume could be useful from a diagnostic and prognostic point of view in thymic cancer and thymoma patients. A large multi-center clinical trial experience for confirming the findings of this study seems mandatory.
Collapse
Affiliation(s)
- Elena Scagliori
- Oncologic Radiology Unit, Veneto Institute of Oncology IOV - IRCCS Padua, Italy
| | - Laura Evangelista
- Radiotherapy and Nuclear Medicine Unit, Veneto Institute of Oncology IOV - IRCCS Padua, Italy
| | - Annalori Panunzio
- Oncologic Radiology Unit, Veneto Institute of Oncology IOV - IRCCS Padua, Italy
| | - Fiorella Calabrese
- Department of Cardiac, Thoracic and Vascular Science, University of Padua Padua, Italy
| | - Nazarena Nannini
- Department of Cardiac, Thoracic and Vascular Science, University of Padua Padua, Italy
| | - Roberta Polverosi
- Department of Radiology, Hospital of San Donà di Piave Venice, Italy
| | - Fabio Pomerri
- Oncologic Radiology Unit, Veneto Institute of Oncology IOV - IRCCS Padua, Italy
| |
Collapse
|
12
|
Ciet P, Serra G, Bertolo S, Spronk S, Ros M, Fraioli F, Quattrucci S, Assael MB, Catalano C, Pomerri F, Tiddens HAWM, Morana G. Assessment of CF lung disease using motion corrected PROPELLER MRI: a comparison with CT. Eur Radiol 2015; 26:780-7. [PMID: 26024847 DOI: 10.1007/s00330-015-3850-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 05/05/2015] [Accepted: 05/13/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To date, PROPELLER MRI, a breathing-motion-insensitive technique, has not been assessed for cystic fibrosis (CF) lung disease. We compared this technique to CT for assessing CF lung disease in children and adults. METHODS Thirty-eight stable CF patients (median 21 years, range 6-51 years, 22 female) underwent MRI and CT on the same day. Study protocol included respiratory-triggered PROPELLER MRI and volumetric CT end-inspiratory and -expiratory acquisitions. Two observers scored the images using the CF-MRI and CF-CT systems. Scores were compared with intra-class correlation coefficient (ICC) and Bland-Altman plots. The sensitivity and specificity of MRI versus CT were calculated. RESULTS MRI sensitivity for detecting severe CF bronchiectasis was 0.33 (CI 0.09-0.57), while specificity was 100% (CI 0.88-1). ICCs for bronchiectasis and trapped air were as follows: MRI-bronchiectasis (0.79); CT-bronchiectasis (0.85); MRI-trapped air (0.51); CT-trapped air (0.87). Bland-Altman plots showed an MRI tendency to overestimate the severity of bronchiectasis in mild CF disease and underestimate bronchiectasis in severe disease. CONCLUSIONS Motion correction in PROPELLER MRI does not improve assessment of CF lung disease compared to CT. However, the good inter- and intra-observer agreement and the high specificity suggest that MRI might play a role in the short-term follow-up of CF lung disease (i.e. pulmonary exacerbations). KEY POINTS PROPELLER MRI does not match CT sensitivity to assess CF lung disease. PROPELLER MRI has lower sensitivity than CT to detect severe bronchiectasis. PROPELLER MRI has good to very good intra- and inter-observer variability. PROPELLER MRI can be used for short-term follow-up studies in CF.
Collapse
Affiliation(s)
- Pierluigi Ciet
- Radiology Department, General Hospital Ca' Foncello, Treviso, Italy.,Pediatric Pulmonology Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands.,Radiology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Silvia Bertolo
- Radiology Department, General Hospital Ca' Foncello, Treviso, Italy
| | - Sandra Spronk
- Radiology, Erasmus MC, Rotterdam, The Netherlands.,Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Mirco Ros
- Pediatrics, Ca' Foncello Hospital, Treviso, Italy
| | - Francesco Fraioli
- Institute of Nuclear Medicine, University College London (UCL), London, UK
| | | | | | | | - Fabio Pomerri
- Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Harm A W M Tiddens
- Pediatric Pulmonology Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands.,Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Giovanni Morana
- Radiology Department, General Hospital Ca' Foncello, Treviso, Italy.
| |
Collapse
|
13
|
De Carlo D, Zotto LD, Carollo C, Porzionato A, D'Avella D, Pomerri F, Battistella PA. Spontaneous involution of diffuse fibrous dysplasia of paranasal sinuses. J Child Neurol 2015; 30:767-71. [PMID: 24907138 DOI: 10.1177/0883073814534319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 04/08/2014] [Indexed: 12/29/2022]
Abstract
We report the case of a 25-year-old patient, diagnosed at age 10, with diffuse fibrous dysplasia of the paranasal sinuses, an extremely rare idiopathic condition. This diagnosis is possible only by cerebral computed tomography (CT), cerebral and anterior skull base magnetic resonance imaging (MRI), and histopathology. Surgical treatment is common. This boy had mild symptoms: moderate headache in the morning that did not affect his daily activity, and rhinitis, partially responsive to medication. The neurologic examination was abnormal. Radiographs, CT, and MRI showed a diffuse mass in the paranasal sinuses which had a histopathological diagnosis of fibrous dysplasias. The family refused to refer the patient to surgery. The boy has been monitored annually for 15 years. He has remained asymptomatic without headache since age 11, with normal, general and neurologic examinations. Serial MRIs showed a spontaneous partial involution of the mass.
Collapse
Affiliation(s)
- D De Carlo
- Department of Woman's and Child Health, University of Padua, Padua, Italy
| | - L Dal Zotto
- Department of Woman's and Child Health, University of Padua, Padua, Italy
| | - C Carollo
- Department of Neuroradiology, University-Hospital of Padua, Padua, Italy
| | - A Porzionato
- Department of Human Anatomy and Physiology, University of Padua, Padua, Italy
| | - D D'Avella
- Department of Neurosurgery, University of Padua, Padua, Italy
| | - F Pomerri
- Department of Radiology of Oncology Institute of Padua IOV, Padua, Italy
| | - P A Battistella
- Department of Woman's and Child Health, University of Padua, Padua, Italy
| |
Collapse
|
14
|
Pomerri F, Opocher G, Dal Bosco C, Muzzio PC, Gennaro G. Optimal follow-up intervals in active surveillance of renal masses in patients with von Hippel-Lindau disease. Eur Radiol 2015; 25:2025-32. [PMID: 25636418 DOI: 10.1007/s00330-015-3591-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 12/17/2014] [Accepted: 01/12/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To estimate an optimal follow-up (FU) interval for von Hippel-Lindau (VHL) patients with renal masses (RMs) by determining tumour growth rates from growth curves. METHODS Thirty lesions (47.6%) were classified as solid tumours (STs) and 33 (52.4%) as complex cysts (CCs). Variations in lesion volume over time were analyzed. For 53 lesions, we calculated the growth rate during the period when the volume of the lesion changed most rapidly, and called this the fast growth rate (FGR). RESULTS The STs initially grew fast, followed by a period of slower growth. The CCs varied in volume over time, associated with variable amounts of their fluid component. The FGR correlated better with the latest volume for STs (r = 0.905) than for CCs (r = 0.780). An optimal FU interval between 3 and 12 months was derived by combining the FGR calculated from the curve with the latest volume measured. CONCLUSIONS Analyzing growth curves and related kinetic parameters for RMs in VHL patients could be useful with a view to optimizing the subsequent FU interval and improving the active surveillance program. KEY POINTS • Measuring volume changes over time enables tumour growth curves to be charted. • Renal solid tumours increase in volume with a typical sigmoidal curve. • Complex cysts may increase and decrease in volume spontaneously over time. • The fast growth rate of solid tumours correlates with their latest volume. • The fast growth rate can orient the scheduling of subsequent follow-ups.
Collapse
Affiliation(s)
- Fabio Pomerri
- Radiology Unit, Veneto Institute of Oncology IOV-IRCCS, via Gattamelata, 64, 35128, Padua, Italy
| | | | | | | | | |
Collapse
|
15
|
Vincenzi M, Pasquotti G, Polverosi R, Pasquali C, Pomerri F. Imaging of pancreatic metastases from renal cell carcinoma. Cancer Imaging 2014; 14:5. [PMID: 25609358 PMCID: PMC4212532 DOI: 10.1186/1470-7330-14-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 02/28/2014] [Indexed: 11/13/2022] Open
Abstract
Background To describe the main imaging characteristics of pancreatic metastases from renal cell carcinoma (RCC) with particular attention to CT features, underlining possible criteria for a differential diagnosis. Methods 15 patients have been included in this study. 14 patients underwent multislice CT with triphasic acquisition (unenhanced, pancreatic parenchymal and portal venous phases). In 9 cases a delayed phase (120 sec) was also acquired. 5 patients underwent MRI, before and after administration of gadolinium. Results The mean time interval between nephrectomy and recurrence was 7.5 years (range 1-17 years). On CT metastases avidly enhanced in the parenchymal phase and then demonstrated a significant wash-out, approaching isodensity to the normal pancreatic parenchyma in the portal phase. In the portal phase 20 of the 25 lesions found in the arterial phase were recognizable. On non-enhanced scans, only 13 of the 25 lesions were detected. On MRI, with the limitations due to the paucity of cases, the metastatic foci appeared hypointense to normal pancreatic tissue on T1-weighted images, and hyperintense on T2- and diffusion-weighted images. After gadolinium, the behaviour was similar to that reported for CT, except for one patient in whom two metastatic foci presented a signal intensity almost isointense to the surrounding parenchyma, accompanied also by an unusual lowering of the signal on DWI (diffusion-weighted imaging) with high b-values. Compared to CT, with MRI the lesions appeared all detectable even on non-enhanced acquisitions. Conclusion Renal Cell Carcinomas require a prolonged CT or MRI follow-up. In patients with RCC history, an early arterial or a pancreatic parenchymal phase is always mandatory, as pancreatic metastases typically present themselves as hypervascular lesions. This behavior is similar to that of neuroendocrine tumors, while the other primary pancreatic tumors tend to be hypovascular.
Collapse
|
16
|
Polverosi R, Russo R, Coran A, Battista A, Agostini C, Pomerri F, Giraudo C. Typical and atypical pattern of pulmonary sarcoidosis at high-resolution CT: relation to clinical evolution and therapeutic procedures. Radiol Med 2013; 119:384-92. [PMID: 24297591 DOI: 10.1007/s11547-013-0356-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 05/28/2013] [Indexed: 11/29/2022]
Abstract
AIM This study was done to evaluate the importance of high-resolution CT (HRCT) in defining pattern and extent of disease and establishing the clinical and therapeutic pathway in sarcoidosis. MATERIALS AND METHODS A retrospective analysis of 56 patients with pulmonary involvement of sarcoidosis was performed. Two groups were identified: 39 patients exhibiting a typical HRCT pattern and 17 patients with an atypical pattern. Inclusion criteria were the presence of radiological documentation (HRCT) of disease, clinical and radiological follow-up of 1 year and the beginning of any therapy within 1 month from the diagnosis. RESULTS Among subjects not receiving therapy, the comparison between the two groups showed that the radiological findings remained stable in subjects with a typical pattern, while they worsened in more than 70% of cases with atypical appearance. Therapy was more effective in patients with a typical pattern. Recurrences occurred in both groups, but more often in patients with a typical pattern. One patient not receiving treatment experienced clinical worsening. Re-evaluation of HRCT within 1 year revealed no correlation between clinical deterioration and radiological changes. CONCLUSIONS The findings of this study suggest that persistence of the inflammatory process rather than the radiological pattern at onset is a prognostic factor for recurrence.
Collapse
Affiliation(s)
- Roberta Polverosi
- UOC Radiologia, Ospedale S. Donà di Piave, Via N. Sauro, 30027, S Donà di Piave, VE, Italy,
| | | | | | | | | | | | | |
Collapse
|
17
|
Pomerri F, Cervino AR, Al Bunni F, Evangelista L, Muzzio PC. Therapeutic impact of (18)F-FDG PET/CT in recurrent differentiated thyroid carcinoma. Radiol Med 2013; 119:97-102. [PMID: 24277507 DOI: 10.1007/s11547-013-0323-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 10/17/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE (18)F-fluorodeoxyglucose-positron emission tomography/computed tomography (PET/CT) has proved effective in detecting recurrent or metastatic differentiated thyroid carcinoma (DTC) in the follow-up of operated DTC patients with high thyroglobulin (Tg) levels and negative findings on radioiodine whole-body scan. The aim of this retrospective study was to assess the impact of PET/CT on the planning of appropriate treatment for known recurrent disease in operated DTC patients. MATERIALS AND METHODS The study concerned 44 consecutive DTC patients (36 papillary, 8 follicular), who underwent total thyroidectomy and thyroid remnant ablation with (131)I and PET/CT. All patients had proven or strongly suspected recurrent disease judging from neck ultrasound (US) and fine-needle aspiration cytology, and detectable basal Tg levels. RESULTS PET/CT findings were positive in 25/44 patients (56.81 %) and negative in 19. A positive PET/CT result predicted resectable tumour recurrences in 19/25 patients, but also detected additional tumour sites that prompted changes to the treatment plan in 6/25 patients (24 %). A negative PET/CT result led to clinical monitoring for 11/19 patients (57.89 %). CONCLUSIONS PET/CT can help select patients, who might benefit from a tailored therapy by improving the detection of local recurrences not apparent on neck US or metastases.
Collapse
Affiliation(s)
- Fabio Pomerri
- Veneto Institute of Oncology IOV-IRCCS, Oncologic Radiology Unit, Via Gattamelata 64, 35128, Padua, Italy,
| | | | | | | | | |
Collapse
|
18
|
Lombardi G, Pambuku A, Bellu L, Della Puppa A, Rumanò L, Gardiman MP, Pomerri F, Zagonel V. Cisplatin and temozolomide combination in the treatment of supratentorial anaplastic ependymoma. Chemotherapy 2013; 59:176-80. [PMID: 24192541 DOI: 10.1159/000355662] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 09/06/2013] [Indexed: 11/19/2022]
Abstract
Anaplastic ependymomas are rare tumors in adult patients. Maximal safe resection and use of radiation therapy are standard treatment approaches in patients with anaplastic ependymoma. Recurrent anaplastic ependymomas are treated by reoperation when the tumors are surgically accessible, by radiotherapy if not previously administered and by salvage chemotherapy. However, the role of chemotherapy is still unclear. A few retrospective studies showed interesting results with platinum-based regimens, while the administration of temozolomide alone demonstrated conflicting results. We present, for the first time, the case of a patient with anaplastic ependymoma refractory to platinum-based chemotherapy and temozolomide only, but showing a prolonged reduction of the lesion after receiving combination chemotherapy with cisplatin and temozolomide. A brief review of the literature on the treatment of anaplastic ependymoma follows.
Collapse
Affiliation(s)
- Giuseppe Lombardi
- Medical Oncology 1, Veneto Institute of Oncology - IRCCS, Padua, Italy
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Gennaro G, Hendrick RE, Ruppel P, Chersevani R, di Maggio C, La Grassa M, Pescarini L, Polico I, Proietti A, Baldan E, Bezzon E, Pomerri F, Muzzio PC. Performance comparison of single-view digital breast tomosynthesis plus single-view digital mammography with two-view digital mammography. Eur Radiol 2012; 23:664-72. [PMID: 22976919 DOI: 10.1007/s00330-012-2649-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 07/25/2012] [Accepted: 08/05/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the performance of combined single-view mediolateral oblique (MLO) digital breast tomosynthesis (DBT) plus single-view cranio-caudal (CC) mammography (MX) compared with that of standard two-view digital mammography. METHODS A multi-reader multi-case (MRMC) receiver-operating characteristic (ROC) study was conducted, involving six breast radiologists. Two hundred fifty patients underwent bilateral MX and DBT imaging. MX and DBT images with the adjunct of the CC-MX view from 469 breasts were evaluated and rated independently by six readers. Differences in mean areas under the ROC curves (AUCs), mean sensitivity and mean specificity were analysed by analysis of variance (ANOVA) to assess clinical performance. RESULTS The combined technique was found to be non-inferior to standard two-view mammography (MX((CC+MLO))) in mean AUC (difference: +0.021;95 % LCL = -0.011), but was not statistically significant for superiority (P = 0.197). The combined technique had equivalent sensitivity to standard mammography (76.2 % vs. 72.8 %, P = 0.269) and equivalent specificity (84.9 % vs. 83.0 %, P = 0.130). Specificity for benign lesions was significantly higher with the combination of techniques versus mammography (45.6 % vs. 36.8 %, P = 0.002). CONCLUSION In this enriched study population, the combination of single-view MLO tomosynthesis plus single-view CC mammography was non-inferior to that of standard two-view digital mammography in terms of ROC curve area, sensitivity and specificity.
Collapse
Affiliation(s)
- Gisella Gennaro
- Veneto Institute of Oncology (IOV)-IRCCS, via Gattamelata 64, 35128 Padua, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Evangelista L, Baretta Z, Vinante L, Bezzon E, De Carolis V, Cervino AR, Gregianin M, Ghiotto C, Saladini G, Pomerri F, Muzzio PC. Comparison of 18F-FDG positron emission tomography/computed tomography and computed tomography in patients with already-treated breast cancer: diagnostic and prognostic implications. Q J Nucl Med Mol Imaging 2012; 56:375-384. [PMID: 23013667] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM The purpose of the study was to assess the comparison of 18F-FDG PET/CT and CT in patients with breast cancer (BC) already treated with primary therapy, in evaluating the diagnostic and prognostic values. METHODS We retrospectively studied 190 patients (187 women and 3 men, mean age 61±11 years) with previous BC (all stages) after surgery and other primary treatments. They underwent within three months CT and 18F-FDG PET/CT examinations for the evaluation of disease status. Disease relapse was confirmed by clinical evaluation and/or radiological findings. Survival curves of disease-free survival (DFS) and overall survival (OS) were computed using Kaplan-Meier method. Cox analysis regression was used to determine predictive factors of DFS and OS. RESULTS Of the overall 190 patients, 82 (43%) had evidence of clinical and/or imaging disease relapse, while 108 (57%) did not. Sensitivity, specificity, negative predictive and positive predictive values for disease relapse or progression were of 89% vs. 77%, 73% vs. 53%, 90% vs. 75% and 72% vs. 55%, respectively for PET/CT and CT. DFS curves were significantly different in patients with both negative and positive PET/CT and CT (log-rank test 33.6; P<0.0001 and 12.7; P=0.003, respectively). OS curves were similar in patients with positive/negative PET/CT and CT (P=NS). By both univariate and multivariate Cox regression analysis positive PET/CT was found to be related to the disease recurrence (HR 0.18 and 0.20, both P<0.0001, respectively). CONCLUSION PET/CT is more accurate than CT in identification of disease relapse in a large population of BC patients. In women at high-risk of recurrence, PET/CT imaging can provide the early detection of BC metastases, tailoring a proper treatment.
Collapse
Affiliation(s)
- L Evangelista
- Radiotherapy and Nuclear Medicine Unit, Istituto Oncologico Veneto (IOV - IRCCS), Padua, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Pomerri F, Pucciarelli S, Maretto I, Perrone E, Pintacuda G, Lonardi S, Nitti D, Muzzio PC. Significance of pulmonary nodules in patients with colorectal cancer. Eur Radiol 2012; 22:1680-6. [PMID: 22466515 DOI: 10.1007/s00330-012-2431-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Revised: 01/24/2012] [Accepted: 02/16/2012] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Radiographically small pulmonary nodules (PNs) in patients with colorectal cancer are troublesome because their discovery raises concern about metastases. This study sought to establish the appropriate timing of radiological follow-up for PNs detected at initial staging evaluation of colorectal carcinoma patients. METHODS The medical records of 376 consecutive colorectal cancer patients who underwent curative surgery and had baseline and follow-up chest X-rays (CXR) and computed tomography (CT) were reviewed. RESULTS The study included 92 patients who had all CXR and chest CT available for review, at least one PN found on baseline imaging, and no synchronous neoplasms. On baseline chest CT, these 92 patients had 170 PNs altogether and 77 (45.2 %) of them were greater than 5 mm in size. Baseline CXR detected 13 PNs in 12 patients and all but 2 were larger than 5 mm. Nodule size greater than 5 mm and irregular margins were predictors of nodule growth. The mean doubling time of 24/170 (14.1 %) growing PNs was about 4 months. CONCLUSIONS Our findings suggest that baseline and follow-up CXR are pointless, and short-interval CT follow-up is warranted when PNs larger than 5 mm with irregular margins are detected on preoperative chest CT. KEY POINTS • Pulmonary nodules in colorectal cancer patients raise concern about metastasis. • Baseline and follow-up chest X-ray in colorectal cancer can be abandoned. • CT is the best technique for assessing PNs in colorectal cancer. • Short-interval CT follow-up advisable for PNs larger than 5 mm with irregular margins.
Collapse
Affiliation(s)
- Fabio Pomerri
- Oncological Radiology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Pomerri F, Costantini M, Dal Bosco C, Battaglia G, Bottin R, Zanatta L, Ancona E, Muzzio PC. Comparison of preoperative and surgical measurements of Zenker’s diverticulum. Surg Endosc 2012; 26:2010-5. [DOI: 10.1007/s00464-012-2146-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 01/03/2012] [Indexed: 11/28/2022]
|
23
|
Pomerri F, Foletto M, Allegro G, Bernante P, Prevedello L, Muzzio PC. Laparoscopic sleeve gastrectomy--radiological assessment of fundus size and sleeve voiding. Obes Surg 2012; 21:858-63. [PMID: 20730606 DOI: 10.1007/s11695-010-0255-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is now considered an effective bariatric procedure (American Society for Metabolic and Bariatric Surgery statement). We attempted to assess the size of the gastric fundus remaining after LSG and gastric voiding rate (fast/slow) by radiological upper gastrointestinal series (UGS) with a water-soluble contrast medium (CM). The findings were compared with weight loss data. METHODS Seventy-four obese patients underwent LSG. Radiological UGS were used to measure the remaining fundus size in 28 of 74 patients 24-72 h after the procedure, with the aid of Matlab software and a library image processing toolbox (MathWorks®). Sleeve voiding was measured in 57 of 74 patients, based on the patients' radiological reports. RESULTS The mean volume of the remaining fundus was 17.56 ml (range 1.00-77.03 ml). The mean percent excess BMI loss (%EBL) was 39.5%, 53.7%, and 60.8%, respectively, 3, 6, and 12 months after LSG. Sleeve voiding was fast in 49 of 57 patients (85.96%) and slow in eight (14.03%). CONCLUSIONS No correlation was found between the estimated volume of the remaining gastric fundus and weight loss (%EBL) after LSG. Patients showing a rapid gastroduodenal transit of the CM achieved a better weight loss than patients with a slow voiding rate.
Collapse
Affiliation(s)
- Fabio Pomerri
- Radiology Unit, Veneto Institute of Oncology IOV-IRCCS, via Gattamelata 64, 35128, Padua, Italy.
| | | | | | | | | | | |
Collapse
|
24
|
Cervino A, Evangelista L, Alfieri R, Castoro C, Sileni V, Pomerri F, Corti L, Muzzio P. Positron emission tomography/computed tomography and esophageal cancer in the clinical practice: How does it affect the prognosis? J Cancer Res Ther 2012; 8:619-25. [DOI: 10.4103/0973-1482.106580] [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: 11/04/2022]
|
25
|
Aliberti C, Fiorentini G, Muzzio PC, Pomerri F, Tilli M, Dallara S, Benea G. Trans-arterial chemoembolization of metastatic colorectal carcinoma to the liver adopting DC Bead®, drug-eluting bead loaded with irinotecan: results of a phase II clinical study. Anticancer Res 2011; 31:4581-4587. [PMID: 22199334] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
UNLABELLED Trans-arterial chemoembolization (TACE) is a promising locoregional therapy for the treatment of primary hepatic tumors and liver metastases. The aim of the study was to define the activity and outcome of using DC Bead, drug-eluting bead, a spherical embolic device capable of being loaded with irinotecan. PATIENTS AND METHODS We conducted a double institutional, single arm, phase II clinical study to evaluate TACE adopting this device in 82 patients presenting with metastatic colorectal carcinoma to the liver after failing chemotherapy. The primary endpoints were tumor shrinkage, safety, feasibility, compliance, and overall survival. RECIST criteria were used to assess responses. Quality of life (QoL) was addressed using Edmonton SAS improvement scale. RESULTS Out of 103 patients considered, 82 were enrolled and underwent a total of 185 treatments of TACE. The median number of TACE was 2.2 (1-4). A post-embolization syndrome was frequently observed. Adverse observed effects were: right upper quadrant pain (40%), fever (80%), nausea (27%) and increased transaminases (70%). The median follow-up was 29 months. Within one month after treatment, each patient received a computed tomograpic scan. It showed reduction of metastatic contrast enhancement in all patients. Responses were 78% at 3 months. After the first treatment, 75 out 82 patients declared an improvement of their well being lasting more than 18 weeks. The median duration of response was 6 (range 3-10) months; the median follow up was 29 (range 7-48) months. The median survival was 25 (range 6-34) months, with progression free survival at 8 (range 4-16) months. CONCLUSION We suggest that TACE adopting DC Bead®, drug-eluting bead loaded with irinotecan could be proposed as palliative therapy for unresectable and chemotherapy resistant liver metastases from CRC.
Collapse
Affiliation(s)
- Camillo Aliberti
- Unit of Oncological Interventional Radiology, IOV (IRCCS), Padova, Italy.
| | | | | | | | | | | | | |
Collapse
|
26
|
Bilora F, Veronese F, Zancan A, Biasiolo M, Pomerri F, Muzzio PC. Autonomic dysfunction in Hodgkin and non-Hodgkin lymphoma. A paraneoplastic syndrome? Hematol Rep 2010; 2:e8. [PMID: 22184521 PMCID: PMC3222264 DOI: 10.4081/hr.2010.e8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 11/11/2010] [Accepted: 11/20/2010] [Indexed: 11/23/2022] Open
Abstract
We wanted to determine whether autonomic dysfunction in patients with lymphoma is related to chemotherapy or represent a paraneoplastic syndrome. 40 patients with current or cured Hodgkin or non-Hodgkin lymphoma and 40 healthy controls, matched for age, gender, hypertension and diabetes mellitus underwent autonomic evaluation (Deep Breath, Valsalva Maneuver, Hand Grip, Lying to Standing, Tilt Test). Current patients also suffering from diabetes or hypertension, or still on chemotherapy revealed autonomic changes, while cured or healthy subjects did not. Autonomic dysfunction in lymphoma is a transient manifestation of a paraneoplastic syndrome.
Collapse
Affiliation(s)
- Franca Bilora
- 2nd Internal Medicine Clinic University of Padua and IRCSS-IOV, Padua, Italy
| | | | | | | | | | | |
Collapse
|
27
|
Pomerri F, Pucciarelli S, Maretto I, Zandonà M, Del Bianco P, Amadio L, Rugge M, Nitti D, Muzzio PC. Prospective assessment of imaging after preoperative chemoradiotherapy for rectal cancer. Surgery 2010; 149:56-64. [PMID: 20452636 DOI: 10.1016/j.surg.2010.03.025] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Accepted: 03/25/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of the study was to assess the accuracy of imaging techniques in predicting pathologic tumor (ypT), node (ypN) stages and the circumferential resection margin (ypCRM) status of rectal cancers after preoperative chemoradiotherapy (CRT). METHODS Using pelvic computed tomography (CT), magnetic resonance imaging (MRI), and endorectal ultrasound (ERUS), 90 consecutive patients with locally advanced mid-to-low rectal cancer were prospectively assessed. Postirradiation T and N stages and infiltration of the CRM, as assessed by CT, MRI and ERUS, were compared with histopathologic findings. RESULTS The accuracy of ypT staging was low, whatever the imaging technique used (37% by CT, 34% by MRI, and 27% by ERUS), the most frequent inaccuracy being overstaging. Imaging showed a good specificity and good negative predictive values (NPV) when mural staging was grouped into ypT ≤ 3 and ypT4 categories; in particular, ERUS achieved a 92% specificity and 95% NPV. CRM involvement was correctly predicted in 71% of patients by CT (74% specificity; 93% NPV) and in 85% by MRI (88% specificity; 95% NPV). The accuracy for nodal staging was 62%, 68%, and 65% by CT, MRI and ERUS, respectively; the corresponding NPV were 88%, 78%, and 76%. CONCLUSION Current imaging techniques are inaccurate in restaging rectal cancer after CRT but are useful in predicting T ≤ 3 tumors, cases with negative nodes and tumor-free CRM. These findings may be of clinical relevance for planning less invasive surgery.
Collapse
Affiliation(s)
- Fabio Pomerri
- Department of Medical-Diagnostic Sciences and Special Therapies, University of Padua, Padua, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Bilora F, Pietrogrande F, Campagnolo E, Rossato A, Polato G, Pomerri F, Muzzio PC. Are Hodgkin and non-Hodgkin patients at a greater risk of atherosclerosis? A follow-up of 3 years. Eur J Cancer Care (Engl) 2009; 19:417-9. [PMID: 19709173 DOI: 10.1111/j.1365-2354.2008.01048.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Aims and background are to ascertain whether Hodgkin and non-Hodgkin patients are more affected by atherosclerotic process. We studied 96 patients during a period of 3 years (2003-2007). Patients were assessed in the first year soon after receiving radiotherapy and chemotherapy and then reassessed in the third year. All the cases underwent echo-colour Doppler of the carotid axis, and the intima-media thickness (IMT) was measured. When the two time points were compared, the IMT was greater in the arterial district examined at the first assessment; while at the second there was a reduction in the IMT, so patients seemed to improve with time. Flow-mediated dilatation did not improve. Hodgkin and non-Hodgkin patients experience an increase in IMT during treatment, but afterwards they return in their precedent condition. They seem to have a persistently reduced flow-mediated dilatation. Lymphoma therapy probably predisposes patients to early atherosclerosis, and it would be worth trying to reverse this tendency by administering antioxidant therapy.
Collapse
Affiliation(s)
- F Bilora
- 2nd Internal Medicin Clinic, University of Padua and IRCCS-IOV, Padua, Italy.
| | | | | | | | | | | | | |
Collapse
|
29
|
Pomerri F, Dodi G, Nardin M, Muzzio P. Colonic total and segmental transit times in healthy Italian adults. Radiol Med 2009; 114:925-34. [DOI: 10.1007/s11547-009-0409-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Accepted: 11/03/2008] [Indexed: 12/15/2022]
|
30
|
Pomerri F, Zandonà M, Barusco A, Razzoli M, Muzzio P. Comparison of fluoroscopy and radiography in the assessment of colonic transit time using radio-opaque markers. Clin Radiol 2008; 63:1019-25. [DOI: 10.1016/j.crad.2008.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Accepted: 05/08/2008] [Indexed: 12/13/2022]
|
31
|
Pomerri F, Foletto M, Bernante P, Tonello E, Muzzio PC. Radiological assessment of complications after laparoscopic suprabursal adjustable gastric banding for morbid obesity. Obes Surg 2008; 19:146-152. [PMID: 18685904 DOI: 10.1007/s11695-008-9632-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Accepted: 06/27/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND The purpose of this study was to investigate the clinical impact of radiological assessment on delivery of therapy in patients with laparoscopic adjustable gastric banding for morbid obesity who have developed gastroesophageal symptoms or have inadequate excess weight loss. METHODS Institutional review board approval and informed consent were obtained from all patients. Suprabursal banding was performed in 373 patients who underwent 869 upper gastrointestinal series. The control group comprised 59 asymptomatic subjects from the study population with satisfactory weight loss at follow-up. RESULTS There were no intra-operative deaths or gastric perforations. A small gastric pouch was found above the band in 13 (22.03%) of the 59 control subjects; the upper limit of the gastric pouch volume was 9.85 ml (mathematical formula for a sphere used). The main postoperative complications included: 21 of 373 (5.63%) gastric portions above the band with a mean volume of 137.98 ml and narrowed stoma of 0.99 mm; 15 of 373 (4.02%) gastric portions above the band with a mean volume of 33.27 ml and open stoma of 4.95 mm; and 16 of 373 (4.28%) tubing disconnection and displacement into the peritoneal cavity. Twenty-one of 21 narrowed-stoma and eight of 15 open-stoma gastric portions underwent repeat surgery, upward herniation of the stomach (from below the band) being found in all 29 cases. CONCLUSION Our main findings following the use of the suprabursal approach for surgical band positioning suggest that repeat surgery may be worthwhile for all gastric upper portions >10 ml in patients with gastroesophageal symptoms or inadequate excess weight loss.
Collapse
Affiliation(s)
- Fabio Pomerri
- Department of Medical-Diagnostic Sciences and Special Therapies, Radiology, University of Padua, Via Giustiniani 2, 35128, Padua, Italy. .,The Veneto Institute of Oncology (IOV-IRCCS), via Gattamelata 64, 35128, Padua, Italy.
| | - Mirto Foletto
- 2nd Institute of Clinical Surgery, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Paolo Bernante
- 2nd Institute of Clinical Surgery, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Elisa Tonello
- Department of Medical-Diagnostic Sciences and Special Therapies, Radiology, University of Padua, Via Giustiniani 2, 35128, Padua, Italy
| | - Pier Carlo Muzzio
- Department of Medical-Diagnostic Sciences and Special Therapies, Radiology, University of Padua, Via Giustiniani 2, 35128, Padua, Italy.,The Veneto Institute of Oncology (IOV-IRCCS), via Gattamelata 64, 35128, Padua, Italy
| |
Collapse
|
32
|
Angriman I, Scarpa M, Ruffolo C, Pomerri F, Filosa T, Polese L, Pagano D, Norberto L, D’Amico DF. Double contrast small-bowel radiography in the preoperative assessment of Crohn’s disease: Is it still useful? Surg Today 2008; 38:700-4. [DOI: 10.1007/s00595-007-3700-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Accepted: 08/23/2007] [Indexed: 12/22/2022]
|
33
|
Bilora F, Pietrogrande F, Campagnolo E, Rossato A, Polato G, Pomerri F, Pagnan A. A RE HODGKIN AND NON HODGKIN PATIENTS TO A GREATER RISK OF ATHEROSCLEROSIS? A FOLLOW UP OF 3YEARS. ATHEROSCLEROSIS SUPP 2008. [DOI: 10.1016/s1567-5688(08)70320-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
34
|
Foletto M, Bernante P, Busetto L, Pomerri F, Vecchiato G, Prevedello L, Famengo S, Nitti D. Laparoscopic Gastric Rebanding for Slippage with Pouch Dilation: Results on 29 Consecutive Patients. Obes Surg 2008; 18:1099-103. [DOI: 10.1007/s11695-008-9458-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Accepted: 01/31/2008] [Indexed: 11/30/2022]
|
35
|
Pomerri F, Maretto I, Pucciarelli S, Rugge M, Burzi S, Zandonà M, Ambrosi A, Urso E, Muzzio PC, Nitti D. Prediction of rectal lymph node metastasis by pelvic computed tomography measurement. Eur J Surg Oncol 2008; 35:168-73. [PMID: 18359603 DOI: 10.1016/j.ejso.2008.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Accepted: 02/14/2008] [Indexed: 12/31/2022] Open
Abstract
AIM Rectal cancer staging represents a crucial step to select the best treatment for this tumour. Particularly after neo-adjuvant chemoradiotherapy (CRT), it may influence the surgical procedure (e.g. radical resection vs. local excision). The aim of this study was to determine the best lymph node size cut-off at computed tomography (CT) to predict nodal metastasis in rectal cancer patients with and without preoperative CRT. METHODS A consecutive series of patients operated on for primary mid-low rectal adenocarcinoma, all staged with pelvic CT scan, were subdivided as follows: those who underwent surgery alone treatment without CRT (Group A) and those who underwent preoperative CRT (Group B). All CT scans were re-viewed by a single radiologist and, based on the lymph node size, findings were compared with pathologic lymph node status (pN). At each lymph node size cut-off value, the following were calculated: accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). The best cut-off value was defined as having an accuracy >or=70% with the highest NPV. RESULTS The study population consisted of 162 patients: Group A (n=52) and Group B (n=110). Patients classified as pN-positive (n=45) had a higher number of and larger sized lymph nodes by CT scan than patients classified as pN-negative (n=117). The cut-off values with an accuracy >or=70% ranged between 7 and 11 mm in Group A and between 9 and 14 mm in Group B. The cut-off with the best NPV was 7 mm for Group A and 10mm for Group B. CONCLUSIONS Acknowledging the limitations of the dimensional criterion, lymph node size cut-off values found in our study may be useful for planning rectal cancer treatment using CT scan.
Collapse
Affiliation(s)
- F Pomerri
- Department of Diagnostic Sciences and Special Therapies, Istituto Oncologico Veneto, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), University of Padua, Padua, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
OBJECTIVE The objective of our study was to evaluate the feasibility and efficacy of a radiologic technique in increasing colon visibility in colonic transit time studies. Three radiologists counted segmental colonic radiopaque markers in two patient groups, based on classic criteria in the first group and also on a colonic barium trace in the second. Agreement between marker counts was assessed using method comparison analysis. CONCLUSION With the barium trace technique, the anatomic conspicuity of colonic segments is improved, a correct segmental marker count can be obtained, and colonic inertia can be more easily distinguished from distal constipation.
Collapse
Affiliation(s)
- Fabio Pomerri
- Department of Medical Diagnostic Sciences and Special Therapies, Padua University Hospital, Via Giustiniani 2, 35128 Padua, Italy.
| | | | | | | | | |
Collapse
|
37
|
D'Incà R, Pomerri F, Vettorato MG, Dal Pont E, Di Leo V, Ferronato A, Medici V, Sturniolo GC. Interaction between rifaximin and dietary fibre in patients with diverticular disease. Aliment Pharmacol Ther 2007; 25:771-9. [PMID: 17373915 DOI: 10.1111/j.1365-2036.2007.03266.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cyclic administration of rifaximin in association with dietary fibre achieves symptomatic relief in uncomplicated diverticular disease (DD) by means of a still undefined mechanism. AIM To investigate the effects of a combination of rifaximin and fibre on both hydrogen production by intestinal microflora and oro-anal transit time. METHODS In a controlled, double-blind crossover trial, 64 patients with uncomplicated DD were given bran (20 g/day) and randomly treated with rifaximin (1200 mg/day) or a placebo for 14 days. Evaluation was based on clinical status, breath test, oro-anal transit time and faecal weight. RESULTS The global symptomatic score was significantly reduced after rifaximin (7.1 +/- 4.1 to 4.1 +/- 3.3; P < 0.005) but not after placebo (6.8 +/- 3.8 to 6.1 +/- 3.5). Hydrogen production significantly increased after placebo from 198 +/- 134 to 267 +/- 161 ppm/min, while Rifaximin reduced it from 222 +/- 187 to 166 +/- 131 ppm/min (P = 0.05). The total oro-anal transit time decreased from 56.1 +/- 28.2 to 51.3 +/- 28.0 h in placebo and from 54.4 +/- 31.9 to 45.1 +/- 32.4 h (P < 0.05) in rifaximin-treated patients. CONCLUSIONS The administration of rifamixin improves the benefits of dietary fibre in uncomplicated DD by preventing its bacterial degradation.
Collapse
Affiliation(s)
- R D'Incà
- Department of Surgical and Gastroenterological Sciences, University of Padua, Padua, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Bernante P, Foletto M, Busetto L, Pomerri F, Pesenti FF, Pelizzo MR, Nitti D. Feasibility of laparoscopic sleeve gastrectomy as a revision procedure for prior laparoscopic gastric banding. Obes Surg 2007; 16:1327-30. [PMID: 17059742 DOI: 10.1381/096089206778663797] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG), initially described by Gagner's group as the first stage of the laparoscopic duodenal switch in super-obese patients, is now gaining wide diffusion among bariatric surgeons as a new restrictive operation. METHODS From January 2005 to January 2006, 8 obese patients with BMI 37-74 kg/m(2) underwent LSG for conversion from a prior complicated or failed laparoscopic adjustable gastric banding (LAGB). Three patients had severe symptomatic esophageal dilation, while 5 patients had unsuccessful weight loss with poor "band compliance". After de-banding, LSG was calibrated upon a 34-Fr gastric bougie, and blue and green linear staplers were used. The staple-line was buttressed by placing a sero-serosal running suture in all but one patient, and methylene blue dye was used to test for leaks. All the patients underwent upper GI series with water-soluble contrast medium 2 days after the surgery. RESULTS The average operating-time for LSG was 90 minutes (range 60-120 min). The average hospital stay was 4 days (range 3-7). There were no perioperative complications, no conversion, and no mortality. No intraoperative or postoperative blood transfusions were required. CONCLUSIONS LSG proved to be feasible and safe after LAGB. Longer follow-up and larger series are needed to assess weight loss results.
Collapse
Affiliation(s)
- Paolo Bernante
- Istituto di Patologia Speciale Chirurgica, Università di Padova, Italy.
| | | | | | | | | | | | | |
Collapse
|
39
|
Maretto I, Pomerri F, Pucciarelli S, Mescoli C, Belluco E, Burzi S, Rugge M, Muzzio PC, Nitti D. The potential of restaging in the prediction of pathologic response after preoperative chemoradiotherapy for rectal cancer. Ann Surg Oncol 2006; 14:455-61. [PMID: 17139456 DOI: 10.1245/s10434-006-9269-4] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Revised: 10/17/2006] [Accepted: 10/18/2006] [Indexed: 12/16/2022]
Abstract
BACKGROUND We performed this study to prospectively evaluate the postchemoradiotherapy performance of transrectal ultrasonography (TRUS), pelvic computed tomography (CT) scan and magnetic resonance imaging (MRI), and endoscopic biopsies for predicting the pathologic complete response of rectal cancer patients. METHODS Four weeks after completion of preoperative chemoradiotherapy, 46 consecutive patients with mid to low rectal cancer were prospectively evaluated by proctoscopy, TRUS, and pelvic CT scan and MRI. On the basis of T and N status, patients were classified as T0 or T1-4 and N-negative or N-positive. For each staging modality used, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. Findings were compared with the pathologic tumor-node-metastasis stage. RESULTS On histopathologic analysis, 12 patients had pT0 and 34 had pT1-4 lesions; out of 45 assessable patients, 9 were N-positive. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in predicting T status (T0 vs. T >or=1) were 77%, 33%, 74%, 36%, and 64%, respectively, for TRUS; 100%, 0%, 74%, not assessable, and 74% for CT; and 100%, 0%, 77%, not assessable, and 77% for MRI. The corresponding figures in predicting N status (N-negative vs. N-positive) were, respectively, 37%, 67%, 21%, 81%, and 61% for TRUS; 78%, 58%, 32%, 91%, and 62% for CT; and 33%, 74%, 25%, 81%, and 65% for MRI. CONCLUSIONS Current rectal cancer staging modalities after chemoradiotherapy allow good prediction of node-negative cases, although none of them is able to predict the pathologic complete response on the rectal wall.
Collapse
Affiliation(s)
- Isacco Maretto
- Department of Oncological and Surgical Sciences, Clinica Chirurgica II, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Bilora F, Pietrogrande F, Petrobelli F, Polato G, Pomerri F, Muzzio PC. Is radiation a risk factor for atherosclerosis? An echo-color Doppler study on Hodgkin and non-Hodgkin patients. Tumori 2006; 92:295-8. [PMID: 17036519] [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] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
AIMS AND BACKGROUND The aim of the present paper was to study the role of irradiation in the atherosclerotic process in patients affected by Hodgkin and non-Hodgkin lymphoma. METHODS We studied 84 subjects, 42 with Hodgkin or non-Hodgkin disease and 42 controls. All 42 cases had been irradiated and were comparable in terms of risk factors for atherosclerosis. All 84 subjects underwent echo-color Doppler of the arterial axis (carotids, abdominal aorta, and femoral arteries), and the intima-media thickness was measured. RESULTS The irradiated cases had a greater intima-media thickness in the carotid district, even after dividing them according to age and sex; males were affected more than females. The irradiated patients were at greater risk of developing cardiovascular events than the controls. CONCLUSIONS An echo-color Doppler of the carotid district is advisable in all patients who have been submitted to radiotherapy, and the patients with a significantly greater than normal intima-media thickness need a strict follow-up, and antioxidant or antiaggregant therapy should be considered.
Collapse
Affiliation(s)
- Franca Bilora
- 2nd Internal Medicine Clinic, University of Padua and IRCCS-IOV, Padua, Italy.
| | | | | | | | | | | |
Collapse
|
41
|
Foletto M, De Marchi F, Bernante P, Busetto L, Pomerri F. Late Gastric Pouch Necrosis after Lap-Band®, Treated by an Individualized Conservative Approach. Obes Surg 2005; 15:1487-90. [PMID: 16354532 DOI: 10.1381/096089205774859272] [Citation(s) in RCA: 12] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Late band slippage has occurred in nearly 3-10% of patients after laparoscopic adjustable gastric banding (LAGB) with an average delay of 13 months. Band slippage can rarely lead to necrosis of the enlarged pouch, a potentially life-threatening condition. We report a female (BMI 39.92 with co-morbidities) who developed acute outlet obstruction 2 years after LAGB placement. After prompt band deflation, an urgent Gastrografin swallow showed stomach slippage without emptying. At re-operation pouch strangulation was discovered. The pouch appeared to be ill-fated, but as no tear was evident on intra-operative assessment, we decided to simply remove the band and drain. The patient was successfully discharged after 8 days, and the last upper endoscopy showed only a large ulcer in the fundus that was healing. Proper and prompt management of symptomatic patients with stomach slippage, with early operation when acute obstruction is evident, can enable a successful stomach-sparing approach.
Collapse
Affiliation(s)
- Mirto Foletto
- Clinica Chirurgica II, University of Padua, Padua, Italy.
| | | | | | | | | |
Collapse
|
42
|
Bernante P, Francini Pesenti F, Toniato A, Zangrandi F, Pomerri F, Pelizzo MR. Obstructive symptoms associated with the 9.75-cm Lap-Band in the first 24 hours using the pars flaccida approach. Obes Surg 2005; 15:357-60. [PMID: 15826469 DOI: 10.1381/0960892053576541] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND For some patients, especially those with a higher BMI, a non-selective Lap-Band placement using the pars flaccida approach with application of the small-diameter bands (9.75 and 10 cm) may be too tight or may require significant gastroesophageal junction dissection and thinning. In such a case, the major perioperative complication is acute obstruction immediately after surgery. We review the etiology of obstructive complications that present postoperatively in the first 24 hours. CASE REPORTS Acute postoperative stoma obstruction (esophageal outlet stenosis) was observed in 5 patients who underwent 9.75-cm Lap-Band placement for morbid obesity. 2 of these patients had a postoperative upper GI series showing a misplaced band with gastric slippage, and repeat operation was required. 3 patients had gastric obstruction without slippage. Of the latter, 1 patient insisted that the band be removed rather than being replaced with a longer one, and the remaining 2 were managed with conservative treatment, involving extended hospitalization until the edema subsided and the patient slowly regained the ability to swallow. CONCLUSION Obstructive symptoms associated with the Lap-Band using the pars flaccida approach can be addressed conservatively in most patients or by minimally invasive surgery; however we believe that routine use of the 11-cm Lap-Band for the pars flaccida approach could easily prevent this early complication.
Collapse
Affiliation(s)
- Paolo Bernante
- Department of Medical and Surgical Sciences, Surgical Pathology, Padua University Hospital, Italy.
| | | | | | | | | | | |
Collapse
|
43
|
Pomerri F, Bilora F, Muzzio PC. A gastric hiatal hernia may make abdominal pain disappear. J Med 2004; 35:257-263. [PMID: 18084882] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Recurrent abdominal pain developed in a 74-year-old woman that chronically suffered from retrosternal pain and regurgitation. An erect abdominal plain film showed a fluid level in the ascending colon and an enlargement of the posterior lower mediastinum containing gas on the right. Unexpectedly, the patient reported that abdominal pain disappeared after meals. Double contrast enema and contemporaneous barium swallow showed herniation of the left colonic flexure into the left lower mediastinum and a gastric hernia within the right lower mediastinum, respectively. The hernias were in the same site of the enlargement of the mediastinum seen on the plain abdominal film. The colonic hernia partially reduced when the gastric hernia was filled with barium. We postulate that these findings could explain the disappearance of the colic obstruction and abdominal pain after meals.
Collapse
Affiliation(s)
- Fabio Pomerri
- Department of Medical Diagnostic Sciences and Special Therapies, Padua University Hospital, via Giustiniani 2, 35128 Padua, Italy.
| | | | | |
Collapse
|
44
|
Pomerri F, De Marchi F, Barbiero G, Di Maggio A, Zavarella C. Radiology for Laparoscopic Adjustable Gastric Banding: a Simplified Follow-up Examination Method. Obes Surg 2003; 13:901-8. [PMID: 14738679 DOI: 10.1381/096089203322618740] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to identify factors which allow a reliable, standardized and simplified approach for the radiologic follow-up of obese patients who have undergone surgery for laparoscopic adjustable gastric banding (LAGB) placement. METHODS A study was made of 370 consecutive single-contrast upper gastrointestinal series in 159 consecutive patients (122 women, 31 men; mean age 40.6 years; mean body weight 135.8 kg) who had undergone LAGB for morbid obesity and were symptomatic or had inadequate weight loss. The control group consisted of 38 subjects who had undergone LAGB, had satisfactory weight loss and were asymptomatic at follow-up. RESULTS Each gastric portion above the band was satisfactorily evaluated by measuring its vertical diameter. The optimal projection for measurement of stoma size was predicted before administration of the contrast agent and was achieved when the band was visualized in profile. The clinical pictures were not always related to stoma size. Surgical complications were gastric herniation (8 patients, twice in 1 patient, 5.7%), malpositioned band (1 patient, 1.6%), port twisting (13 patients, 8.2%), and disconnection or leakage of the device (8 patients, 5.0%). CONCLUSION Essential criteria for the radiologic evaluation of LAGB are: position of port and tubing; stoma size; and volume of each upper gastric portion.
Collapse
Affiliation(s)
- Fabio Pomerri
- Department of Medical Diagnostic Sciences and Special Therapies, Radiology, 2nd Institute of Clinical Surgery, Padua University Hospital, Via Giustiniani, Padua, Italy.
| | | | | | | | | |
Collapse
|
45
|
Bilora F, Petrobelli F, Boccioletti V, Pomerri F. Treatment of heart failure and ascites with ultrafiltration in patients with intractable alcoholic cardiomyopathy. Panminerva Med 2002; 44:23-5. [PMID: 11887087] [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] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND In Western countries the excess of alcohol intake causes, secondary, non ischaemic cardiomyopathy and cirrhosis. Frequently, therapy is not effective so ultrafiltration was tried on patients affected, with positive effects on life quality. We tried to verify utility and tolerance to peritoneal ultrafiltration in a group of subjects affected by heart failure secondary to alcoholic cardiomyopathy, refractory to conventional therapy. METHODS Sixteen patients (14 males, 2 females) with heart failure and ascites affected by alcoholic cardiomyopathy were studied. All subjects were in IV class NYHA (New York Heart Association); ejection fraction (EF) was evaluated by echocardiogram and ascites by abdominal ultrasound. Patients were submitted to clinical exam, body weight, abdominal circumference, diuresis and routine biohumoral exams, electrocardiogram and chest X-ray. Subsequently they underwent intermittent nocturnal peritoneal dialysis with a changing cycle of 6-12 hours per session. After 5 days, subjects were checked through echocardiogram and abdominal ultrasound. RESULTS The patients mean age was 56.7 +/- 3.2 years. After ultrafiltration, all subjects showed decreased body weight, abdominal circumference and urea; there was an increase of diuresis and Natriuria. Fifteen subjects entered III NYHA class without variation of EF; all of them showed clinical and echographic reduction of ascites. Mean ultrafiltration quantity was 6.084 ml with mean dialysis hours 20; 7.36% of patients had fever that disappeared within 24 hours with antibiotic therapy. All subjects referred to feel well and the mean hospitalization period was of 7 day in spite of the usual 22 days.
Collapse
Affiliation(s)
- F Bilora
- Department of Medical and Surgery Science, University of Padua, Padua, Italy
| | | | | | | |
Collapse
|
46
|
Pomerri F, Zuliani M, Mazza C, Villarejo F, Scopece A. Defecographic measurements of rectal intussusception and prolapse in patients and in asymptomatic subjects. AJR Am J Roentgenol 2001; 176:641-5. [PMID: 11222196 DOI: 10.2214/ajr.176.3.1760641] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The aim of this study was to provide measurements for the defecographic diagnosis of rectal intussusception and rectal prolapse. MATERIALS AND METHODS Four hundred thirty-seven consecutive patients with defecation and micturition disorders and gynecologic complaints were studied by means of defecography (120 patients), colpodefecography (17 patients), or cystocolpodefecography (300 patients). As a control group, 43 asymptomatic subjects underwent defecographic examination. RESULTS Thirty-five patients were found to have rectal intussusception and 18, to have rectal prolapse. Anterior and posterior rectal wall folding thickness, intussuscipiens diameter, intussusceptum lumen diameter, and the ratio between the intussuscipiens diameter and the intussusceptum lumen diameter were measured in all patients. The findings were compared with those obtained in 13 of 43 asymptomatic subjects with rectal outline changes mimicking intussusception. Rectal folding thickness and the ratio between the intussuscipiens diameter and the intussusceptum lumen diameter were significantly greater in subjects with rectal intussusception and rectal prolapse than in asymptomatic subjects with rectal mucosa folding. CONCLUSION Our findings suggest that dynamic evacuation radiology contributes to making a differential diagnosis between rectal intussusception and mucosal folds in the rectum.
Collapse
Affiliation(s)
- F Pomerri
- Department of Medical Diagnostic Sciences and Special Therapies, Radiology, University of Padua, Via Giustiniani 2, 35128 Padua, Italy
| | | | | | | | | |
Collapse
|
47
|
Bilora F, Manfredini R, Petrobelli F, Vettore G, Boccioletti V, Pomerri F. Chronobiology of non fatal pulmonary thromboembolism. Panminerva Med 2001; 43:7-10. [PMID: 11319511] [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] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND It as been demonstrated that acute myocardial infarction, sudden cardiac death, stroke, and fatal pulmonary embolism show an increased onset rate during certain periods of the day, week, or year. According to some authors, the highest risk appears to occur in the morning, on weekends and during winter. This paper, therefore, intends to examine whether a circadian, weekly, or annual rhythm in the incidence rate of deep vein thrombosis (DVT) and non-fatal pulmonary embolism (PE) in ageing patients does exists. METHODS A survey was conducted into 212 patients affected by DVT and PE, admitted to the Second Medicine Institute of Padua, Italy, over a period of two solar years. Thromboses were diagnosed via echo-Doppler examination of the legs and pulmonary embolism via perfusive and ventilatory scintiphotographs. RESULTS In the overall sample, a circadian variation was found, both for deep vein thrombosis (peak at 12:26 hrs, p=0.001), and pulmonary embolism (peak at 10:26 hrs, p=0.001). A weekly, rhythmic recurrence was also found for the two complaints, with a peak on Saturdays, while no significant annual rhythmic recurrence was found. There was, however, a tendency towards an increase during the winter and summer months. CONCLUSIONS The results may have important clinical applications, both in prevention and in the timing of drug dosage.
Collapse
Affiliation(s)
- F Bilora
- Institute of Medicine II, Department of Medical and Surgical Sciences, University of Padua, Padua, Italy
| | | | | | | | | | | |
Collapse
|
48
|
Bilora F, Petrobelli F, Boccioletti V, Pomerri F. Moderate-dose intravenous immunoglobulin treatment of Job's syndrome. Case report. Minerva Med 2000; 91:113-6. [PMID: 11084845] [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] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Job's syndrome (or hyperimmunoglobulinemia E syndrome) is a rare genetic disease characterized by skin eczema, pyogenic "cold" abscesses, sinopulmonary recidivous infections and high IgE plasma concentrations. Job's syndrome treatment is not satisfactory and cases studied are still limited. To describe the effects of IVIG therapy in a 37-year-old woman with hyper IgE syndrome and pneumonia. We measured IgE serum by immuno-fluorometric test and neutrophil chemotaxis by migration in a Boyden chamber before and after IVIG therapy. A moderate dose of IVIG resolved the clinical-radiological signs of the S. aureus bronchopneumonia and improved cytologic and biohumoral parameters. Intravenous immunoglobulins represent a useful treatment for acute pneumonia in Job's syndrome.
Collapse
Affiliation(s)
- F Bilora
- Department of Surgery and Medicine, Padua University
| | | | | | | |
Collapse
|
49
|
Fries W, Pagiaro E, Canova E, Carraro P, Gasparini G, Pomerri F, Martin A, Carlotto C, Mazzon E, Sturniolo GC, Longo G. The effect of heparin on trinitrobenzene sulphonic acid-induced colitis in the rat. Aliment Pharmacol Ther 1998; 12:229-36. [PMID: 9570257 DOI: 10.1046/j.1365-2036.1998.00293.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Reduced blood coagulability seems to protect against inflammatory bowel disease; pilot studies using heparin in patients with inflammatory bowel disease have reported positive results. AIM To evaluate the effects of heparin treatment on microangiographic and on inflammatory parameters in experimental colitis, induced by trinitrobenzene sulphonic acid (TNBS)-ethanol. METHODS Four groups of rats: (i) controls (saline enema), TNBS-induced colitis with (ii) sham treatment (saline, s.c.), (iii) dexamethasone (0.25 mg/kg/day s.c.) and (iv) heparin (500 U/kg t.d.s., s.c.). Microangiography was performed 2 and 4 days after colitis induction. Partial thromboplastin time, colonic wet weight, macroscopic damage score and mucosal myeloperoxidase (MPO) activity were determined at day 4. RESULTS TNBS-induced colitis caused a reduction in visible bowel wall vessels, which was prevented by heparin (P < 0.05) but not by steroids. The macroscopic damage scores and colon wet weights were similar in all colitis groups. Compared to untreated colitis the MPO activity in heparin-treated animals was of borderline significance. CONCLUSIONS Heparin treatment improved microangiographic features and reduced inflammation to a certain degree. Steroids delayed development of colon hypoperfusion, but were ineffective on MPO activity. It remains to be determined if the observed effects are due to the antithrombotic activity of heparin or to an anti-inflammatory action.
Collapse
Affiliation(s)
- W Fries
- Dipartimento di Medicina Interna, Università di Messina, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Piloni V, Pieri L, Pomerri F, Pittarello F, Salvetti M, Leo E, Brusori S, Bassi F, Rottoli ML, Pucciani F, Lazzini S, Minotto R, Postiglione C, Sacco P, Bernini A, Menchinelli S, Pescatori M, Marmorale C, Frascio M, Pitto G, Grassi R, Genovesi N, Basile M, Anselmetti G, Amadio L. [The 3rd national workshop on defecography: the functional radiology of (neo) rectal ampullae (ileal reservoir, colo-anal anastomosis, continent perineal colostomy)]. Radiol Med 1996; 91:66-72. [PMID: 8614735] [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] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A survey was made in 13 Italian centers with a questionnaire concerning the (a) indications, (b) postoperative complications, (c) functional results and (d) diagnostic imaging modalities related to the making of an ileal or colonic (neo) rectum. Ulcerative colitis (100%), familial polyposis (61.5%) and Crohn's disease (15.3%) were the most common indications for an ileal pouch; rectal cancer (7.96%), chronic inflammatory diseases (15.3%), diverticulosis, rectal prolapse, redundant colon and imperforate anus (7.6% each) were the most common indications for a colonic pouch. Postoperative complications included pelvic abscess (14%), sinus tract/dehiscence (10%) and bowel obstruction (9%). When compared with the S and W variants, the J-shaped ileoanal pouch proved superior because urgency and fecal retention rates were lower (18.4% vs. 44.4% and 23% vs. 28.6%, p < 0.01 and p < 0.05, respectively), despite slightly more frequent staining episodes (15.8% vs. 11.1%; p < 0.05). As for colonic ampullae, fecal retention and provoked evacuation were more frequent in the J pouch and after gracileplasty; urgency and incontinence in the straight colo-anal anastomosis (33.3% vs. 22.2% and 41.6% vs. 33.3%, respectively). The functional outcome was assessed by anal endosonography (available in 4/13 centers), defecography and anorectal manometry. Abnormal findings included: (a) reduced capacity, barium leakage, anal gaping, sphincter damage (urgency and incontinence); (b) barium retention, pouch dilatation, split evacuation, knobs and strictures (fecal retention).
Collapse
|