A peculiar case of diffuse hemangiomatosis of the left hepatic lobe in an asymptomatic adult patient: case report and literature review.

We report a rare case of diffuse hepatic hemangiomatosis (DHH) of the left hepatic lobe coexistent with giant hepatic hemangioma and without extra-hepatic involvement in an asymptomatic adult patient. Liver hemangiomas are the most common benign liver tumors. However, DHH without extra-hepatic involvement has rarely been reported in adults. Furthermore, giant hepatic hemangioma coexistent with DHH is even uncommon, although an association between hemangiomatosis and giant hepatic hemangiomas may be supposed. In this peculiar case, we observed an exclusive and widespread involvement of the left hepatic lobe with a sharp boundary between normal and altered liver parenchyma running along Cantlie's line.

An update on clinical applications of hepatospecific contrast media in magnetic resonance imaging of liver parenchyma.

Hepatobiliary-specific contrast agents are now widely used in magnetic resonance imaging (MRI) of liver parenchyma. As extracellular fluid agents, they provide informations regarding lesion vascularity and their use in the hepatobiliary or delayed phase (DPI), and give additional data regarding hepatocyte presence and function. The aim of this article is to review the recent literature about MRI using hepatobiliary-specific contrast agents and to discuss benefits and limits of their clinical applications. Since November 2008, hepatobiliary contrast agents were routinely employed in our Institution for the characterization of equivocal liver lesions detected by other imaging modalities, and for the evaluation of hepatic nodules in liver cirrhosis. The informations provided are particularly relevant for the detection of metastases, for the differentiation between focal nodular hyperplasia (FNH) and hepatocellular adenoma (HCA), and for the detection and differentiation between dysplastic nodules (DNs) and hepatocellular carcinoma (HCC) in the cirrhotic liver. The role in the cirrhosis grading and the quantification of liver function is still controversial. Finally, their biliary excretion allows evaluation of anatomy and function of the biliary tree. According to our and reported data, hepatobiliary contrast agents are able to improve liver lesions detection and characterization; their introduction in clinical practice has improved MRI diagnostic efficacy/accuracy, allowing to decrease the number of invasive diagnostic procedures.

Sentinel node and radioguided surgery in breast cancer of limited size. Preliminary experience at ASL 1, Massa e Carrara.

The aim of this study was to evaluate the effectiveness of sentinel node (SN) biopsy in breast cancer. Twenty-five female patients classified as T1N0 according to the TNM system of the UICC were evaluated with this procedure from April to October 1999. The day before surgery a subdermal injection of 99mTc-nanocoll within the tissue overlying the neoplastic lesion and subsequent lymphoscintigraphy were performed. In all patients the SN was detected with a radioguided probe during scintigraphy and surgery. Histological examination of the SN for detection of metastases was positive in four patients who subsequently underwent axillary dissection. In the remaining patients with normal SNs no axillary dissection was performed. The preliminary results confirm the validity of the sentinel node procedure.

Tamoxifen and interferon-beta for the treatment of metastatic breast cancer.

It has been demonstrated, both in breast cancer cell lines and in metastatic breast cancer patients with cutaneous lesions that could be biopsied, that treatment with interferon beta (IFN-B) can increase expression of both estrogen (ER) and progesterone receptors (PgR). To evaluate the efficacy and toxicity of the combination of IFN and tamoxifen, 33 metastatic breast cancer patients were treated with the following regimen: IFN-B, 6.0 million units intramuscularly IU 3 times a week for two consecutive weeks followed by IFN-B 6.0 million IU im 3 times a week with concomitant tamoxifen 20 mg orally daily. Patients were pre and postmenopausal with median age of 60 years, median ECOG PS of 0, either ER positive or unknown, and had not received prior hormone therapy for metastatic disease. Overall objective response was observed in 9 (27%) patients. Complete response was observed in 2 cases and partial response in 7 patients. Median duration of response was 7 months (range 2-10). A higher response rate was observed in patients with predominantly soft tissue disease (38%) compared to patients with either dominant bone (18%) or visceral lesions (17%). Toxicity was mild and reversible: low grade fever in 30% of patients and flu-like symptoms in 9% of cases. It appears that IFN-B does not improve the efficacy of tamoxifen in an unselected population of metastatic breast cancer.

[Reliability of sedation in MRI]. / Affidabilità della sedazione in RMN.

In our work we have an enumeration of 1527 sedation cases to carry out RM exams with non co-operating patients, most of them in pediatric age. During the examination the patients were monitored using oximeter and observed by closed circuit camera. The meaningless complications head us to think that deep sedation is a reliable procedure which allows us to work out RM exams during a day-hospital regime.

[Complications of prolonged peridural catheterization in the treatment of cancer pain with opioids]. / Complicazioni da cateterizzazione peridurale prolungata nel trattamento del dolore da cancro con oppioidi.

40 patients in 2 groups of 20 and all subjected to peridural catheterisation for the intermittent infusion of pain-killing opiates are examined. Different catheters and different lengths of time (47.55 and 62.15 days) were adopted for the two groups. Nine different parameters were used in examining the long-term complications. A statistically significant difference was found in three of these parameters. The report concludes with some general remarks on the use of peridural opiates in advanced cancer patients.

[Use of a new oral antibiotic in surgery]. / Impiego in chirurgia d'un nuovo antibiotico orale

Results with pivampicillin, a new ampicillin with complete gastric absorption and capable of producing high tissue levels, in the prevention and treatment of postoperative infection in 31 cases are presented. The antibiotic was effective in 29 cases, 4 of which had a prior history of antibiotic intractability. Side-effects consisted of slight gastric disturbances, with suspension of treatment in 1 case only. No clinically significant changes in the laboratory data were noted.