RESUMEN
Intrahepatic cholangiocarcinoma (ICC) is a rare life-threatening disease, whose only treatment with potential for cure is surgical resection. However, only 27% of patients at most are suitable for surgery when first diagnosed. For patients with unresectable disease, therapeutic options are chemotherapy or chemoradiation. We evaluated the feasibility and safety of oxaliplatin-eluting microspheres transarterial chemoembolization (OEM-TACE) associated with chemotherapy (ChT) in patients affected by unresectable ICC. Between December 2005 and May 2008 we treated nine patients (six female and three male) with unresectable ICC. All patients had undergone OEM-TACE associated with chemotherapy with oxaliplatin and gemcitabine. A retrospective comparison was carried out with a historical group of 11 patients treated with ChT only, estimating the prevalence of adverse effects and the median survival of the two groups. A total of 30 TACEs were performed during the observational time (ranging from one to seven procedures per patient). OEM-TACEs were followed by few adverse effects (AEs), without G4 AEs, according to CTACAE 3.0. According to RECIST criteria, 44% (4/9) of patients achieved partial responses and 56% (5/9) stabilization of disease. Overall survival analysis in the two groups showed a significantly increased survival in patients treated with ChT and OEM-TACE, with respect to those treated with ChT (30 vs. 12.7 months; p=0.004). In conclusion, in our experience OEM-TACE associated with ChT in the treatment of advanced unresectable ICC is a safe and feasible treatment causing no major adverse events. Although RECIST criteria can underestimate the rate of responses in patients treated with locoregional therapies, we achieved very encouraging results. A randomized multicentric trial is warranted to assess the actual superiority of OEM-TACE associated with ChT compared to conventional chemotherapy.
Asunto(s)
Neoplasias de los Conductos Biliares/terapia , Conductos Biliares Intrahepáticos , Quimioembolización Terapéutica/métodos , Colangiocarcinoma/terapia , Anciano , Desoxicitidina/administración & dosificación , Desoxicitidina/análogos & derivados , Estudios de Factibilidad , Femenino , Humanos , Masculino , Microesferas , Compuestos Organoplatinos/administración & dosificación , Oxaliplatino , Cuidados Paliativos , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento , GemcitabinaRESUMEN
BACKGROUND/AIMS: In this report, the feasibility and efficacy of laparoscopic radiofrequency interstitial thermal ablation of hepatocellular carcinoma has been evaluated in 20 patients. METHODOLOGY: The laparoscopic approach with the use of intraoperative ultrasonography allowed us to obtain additional information regarding liver nodules and a complete treatment of the liver lesions. RESULTS: The complication rate was low and there was no operative mortality. A complete necrosis has been obtained in 90% of the cases at 1 month dynamic computed tomography following the treatment. CONCLUSIONS: Laparoscopic radiofrequency thermal ablation of hepatocellular carcinoma proved to be a safe and effective technique; its use may be proposed in selected patients. Larger series are needed to accurately assess its role among the other ablative therapies of hepatocellular carcinoma.
Asunto(s)
Carcinoma Hepatocelular/cirugía , Ablación por Catéter , Laparoscopía , Cirrosis Hepática/complicaciones , Neoplasias Hepáticas/cirugía , Ultrasonografía Intervencional , Anciano , Carcinoma Hepatocelular/diagnóstico por imagen , Ablación por Catéter/efectos adversos , Ablación por Catéter/métodos , Endosonografía , Femenino , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Masculino , Persona de Mediana EdadRESUMEN
Aim of this report is to present a case of acute occlusion of the abdominal aorta recognized by spiral-CT. After a brief description of the etiology and pathology of abdominal aorta acute occlusion, stress is laid on diagnostic role of spiral-CT, based on personal and literature data. The advantage of spiral respect to non-spiral CT is the quicker examination time which is very important, mostly in emergencies. On the contrary, the diagnosis of acute abdominal aorta occlusion is not modified by volumetric CT respect to non-spiral and it is based on the absence of aorta contrast enhancement above the occlusion level.
Asunto(s)
Aorta Abdominal , Enfermedades de la Aorta/diagnóstico por imagen , Tromboembolia/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Enfermedad Aguda , Anciano , Anciano de 80 o más Años , Diagnóstico Diferencial , Humanos , Masculino , Radiografía TorácicaRESUMEN
PURPOSE: Primary immunodeficiencies (PI) are a heterogeneous and relatively uncommon group of conditions. As a result of one or more immune system abnormalities, PI decrease the body resistance to infections. The respiratory tract is affected in most cases as a result of its natural exposure to pathogenic agents; repeated infections can lead to pulmonary alterations. We investigated the yield of High Resolution CT (HRCT) and Helical CT in pediatric patients with different PI and then correlated the CT patterns with the patients' clinical history and physical status. MATERIAL AND METHODS: We examined 19 pediatric patients with different types of PI. All patients presented recurrent infections (rhinosinusitis, bronchitis, bronchopneumonia) with cough and chronic catarrh for at least 3 months a year. Fifteen patients were examined with HRCT and 4 with Helical CT. Images were evaluated for presence and severity of alveolitis, bronchiectasis, peribronchial thickening, mucous plugs, air trapping, bronchiolitis, consolidation, abscesses, bullae, emphysema and fibrotic changes. All parameters were given a score and a partial and an overall score calculated for each parameter. All scores were compared to study the correlations between CT patterns, clinical history and patients' status and for possible characterization of the different groups by CT patterns. Finally, all alterations were classified by their anatomical distribution in each pulmonary lobe. RESULTS: Scores ranged 0 to 18, with a mean of 8.1 points. There were no correlations between CT patterns, patients' history and clinical status and any disease type. The midlobe was the preferential site for bronchiectasis while lower lobes were more involved by other conditions, such as consolidation, air trapping and alveolitis. CONCLUSIONS: Both HRCT and Helical CT proved to be useful tools for monitoring PI patients. The two techniques can be especially valuable in symptomatic patients with negative radiographic findings because they can show (non-)reversible damage, which helps improve planning of drug and/or physical therapy. The scoring system, even if not closely correlated with clinical signs, could be a major tool for PI follow-up and for monitoring treatment success.
Asunto(s)
Enfermedades del Sistema Inmune/congénito , Enfermedades Pulmonares/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adolescente , Niño , Preescolar , Femenino , Humanos , Enfermedades del Sistema Inmune/complicaciones , Enfermedades Pulmonares/inmunología , Masculino , Tomografía Computarizada por Rayos X/métodosAsunto(s)
Aneurisma Roto/diagnóstico por imagen , Arterias Bronquiales/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Anciano , Aneurisma Roto/complicaciones , Aneurisma Roto/cirugía , Arterias Bronquiales/cirugía , Urgencias Médicas , Hemoptisis/diagnóstico por imagen , Hemoptisis/etiología , Humanos , Masculino , Tomografía Computarizada por Rayos X/métodosRESUMEN
We retrospectively evaluated a group of human immunodeficiency virus (HIV)-negative adult patients with hilar and/or mediastinal tubercular adenopathy to assess their epidemiological, clinical and radiological features. Out of 3,003 intrathoracic tuberculosis (TB) cases (of which 745 were immigrants from various developing countries) observed in our Institute from 1986-1996, 8 Italians and 52 immigrants were selected. Case history analysis, and standard chest radiography were performed in all cases, while other investigations such as a tuberculin test, sputum and culture examination for Mycobacterium tuberculosis, computed tomography (CT) scanning and biopsy were performed in the majority of patients. Less frequently, bronchoscopy, mediastinoscopy, and echography were also performed. Right paratracheal adenopathy was found most frequently (29 cases), as previously described. CT scanning showed a central necrosis pattern in 31 cases, while normo/hyperdensity occurred in 11 cases. M. tuberculosis was detected in sputum smear and/or culture in only 16 patients. Our study confirms that, when HIV-positive patients are excluded, this peculiar TB location occurs more frequently in immigrants than in the indigenous Italian population (7.0 versus 0.3%, p < 0.001). People from the Indian subcontinent and Senegal are the most frequently involved nationalities among the immigrants present in Milan.
Asunto(s)
Tuberculosis Ganglionar/epidemiología , Adulto , Asia/etnología , Emigración e Inmigración , Femenino , Seronegatividad para VIH , Humanos , India/etnología , Italia/epidemiología , Pulmón/diagnóstico por imagen , Masculino , Mycobacterium tuberculosis/aislamiento & purificación , Estudios Retrospectivos , Senegal/etnología , Tomografía Computarizada por Rayos X , Tuberculosis Ganglionar/diagnósticoRESUMEN
Bronchioloalveolar carcinoma (BAC) is a relatively uncommon tumor of the lung accounting for 1 to 9% of all pulmonary neoplasms. Its radiologic appearance is characterized by solitary nodular opacity or diffuse air-space consolidation. The aim of this work is to report the different patterns of this neoplasm, particularly in the diffuse form, and to demonstrate the sensitivity and specificity of HRCT in its early identification. We examined 11 patients affected with multifocal bronchioloalveolar carcinoma to identify HRCT signs which could lead to improved diagnostic criteria. These signs are represented by ground-glass opacity (8/11) and alveolar consolidation (6/11), with a plurilobular, segmentary or lobar distribution. The lesions were bilateral in 8/11 cases and abnormal mediastinal lymph nodes were found in 5/11 cases. Air bronchogram was seen in all cases of ground-glass opacity and in 5/11 cases of air-space consolidation. In conclusion, in our experience, HRCT is a useful tool in the study of BAC, which has a long and slow evolution and is underestimated at chest radiograph in its early stage. Moreover, HRCT can help distinguish this condition from other lung diseases characterized by diffuse air-space consolidations, whose clinical history is useless to make an unquestionable diagnosis.
Asunto(s)
Adenocarcinoma Bronquioloalveolar/diagnóstico por imagen , Neoplasias Pulmonares/diagnóstico por imagen , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X/métodosRESUMEN
A 71-year-old woman with a solitary kidney who developed acute renal failure with anuria secondary to a spontaneous perirenal hematoma is described. Serum creatinine peaked at 335.9 micromol/L and BUN at 26.4 mmol/L, but neither surgery nor dialysis treatment was performed because renal function gradually improved. In this syndrome, first described by Wunderlich in 1856, anuria was not previously reported. Conservative management must always be considered rather than emergency surgery, which usually results in nephrectomy.
Asunto(s)
Anuria/etiología , Hematoma/complicaciones , Enfermedades Renales/complicaciones , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/etiología , Anciano , Anuria/diagnóstico , Femenino , Hematoma/diagnóstico , Humanos , Riñón/diagnóstico por imagen , Enfermedades Renales/diagnóstico , Nefrectomía , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
We retrospectively reviewed CT scans of 18 patients (12 males and 6 females; mean age: 43.6 years) with the diagnosis of blunt splenic trauma. All patients underwent CT at different times after the trauma. The cases were divided into 2 groups: according to the time at which the CT was performed, the 1st group consisted of 11 patients scanned within 48 h after the trauma; the 2nd group consisted of 7 patients studied with CT at variable times after the traumatic event (mean time: 6.5 days; range 3-13 days). All lesions in the 1st group (11 patients) had indistinct margins, while lesions of patients in the 2nd group (7 patients) always showed clean-cut and regular edges. Early lesions were always hyperdense, late ones hypodense. CT diagnosis always matched the surgeon's diagnosis. We can confirm the diagnostic value of CT of splenic lesions in blunt abdominal traumas.
Asunto(s)
Bazo/lesiones , Rotura del Bazo/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Heridas no Penetrantes/diagnóstico por imagen , Adolescente , Adulto , Anciano , Femenino , Hemoperitoneo/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Bazo/diagnóstico por imagenRESUMEN
342 short-stature patients were examined to assess the agreement between anagraphic and bone ages. 190 men and 152 women (age range: 0 to 17.5 years) underwent conventional radiographs of the left wrist. The radiographs were studied with the TW2 method which provides an index of the skeletal maturity of short and long bones and a global index of the hand. The bone ages thus obtained were compared with anagraphic ages. Patients' statures were compared with their parents' ones. Finally, radiation exposures were evaluated. Anagraphic and bone ages were in agreement in 199 patients and in disagreement in 220. Three patients were adult. The short stature in 78 patients was in agreement with their parents' one, while 253 patients had at least one parent with normal stature. No comparison could be made in 11 patients. In conclusion, TW2 is a simple method to calculate bone age (in months and years) and to select the patients to submit to further examinations and to hormone therapy.
Asunto(s)
Determinación de la Edad por el Esqueleto/métodos , Estatura , Adolescente , Desarrollo Óseo , Huesos del Carpo/diagnóstico por imagen , Niño , Preescolar , Femenino , Trastornos del Crecimiento/diagnóstico por imagen , Mano/diagnóstico por imagen , Humanos , Lactante , Italia , MasculinoRESUMEN
The results of a retrospective review of the conventional radiographs performed on head injury patients are reported. Skull radiography findings were compared with clinical symptoms and CT results, when CT was performed, to investigate the presence of intracranial lesions. The radiographs of 2,285 adult patients of both sexes were evaluated: skull fractures were observed in 21/2,285 patients (0.9%) only. CT was positive for an intracranial lesion in 18 of 21 patients (85.71%). Clinical symptoms were divided into three groups according to lesion severity and to neurologic impairment. 979 patients were asymptomatic and 1,306 were symptomatic: 1,114 patients were included in group I, their symptoms being nausea, vomit and loss of consciousness for less than ten minutes, 124 were included in group II (epistaxis and loss of consciousness for more than 10 minutes) and 68 were included in group III (coma and focal neurologic signs). All the patients in groups II and III and 30 patients in group I were submitted to CT--222 CT exams on the whole. Thirty-five patients in group III and 9 in group II had an intracranial lesion on CT, while CT findings were normal in all group-I patients. Thus, we conclude that the presence of a skull fracture is not always correlated with the presence of intracranial lesions. The latter are more likely to be correlated with clinical symptoms, especially coma and neurologic impairement. Therefore, the higher value is confirmed of the clinical examination than of conventional radiographs in head injury patients.
Asunto(s)
Traumatismos Craneocerebrales/diagnóstico , Adolescente , Adulto , Anciano , Lesiones Encefálicas/diagnóstico , Niño , Preescolar , Protocolos Clínicos , Traumatismos Craneocerebrales/diagnóstico por imagen , Árboles de Decisión , Femenino , Humanos , Lactante , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Fracturas Craneales/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
The CT scans of 18 patients (12 males and 6 females; mean age: 43.6 years) with splenic blunt trauma were reviewed. CT examinations had been made at different times after trauma. The CT images were grouped according to the time of examination and both structure and densitometry were evaluated in all lesions. In all cases CT findings were correlated with surgical and pathologic data. The patients were divided into two groups: group I included 11 subjects in whom CT had been performed within 48 hours following trauma and group II included 7 patients who had undergone CT at different times after trauma (3-13 days; mean: 6.5 days). All the lesions in group I exhibited blurred outlines, while the lesions in group II had clear-cut margins. The lesions in group I were always hyperdense while those in group II were hypodense. CT diagnosis was always in agreement with surgical findings. In conclusion, we confirm the value of CT in the examination of splenic lesions by blunt abdominal trauma. The evolution of splenic lesions is usually typical: CT yields useful information for injury evaluation and is therefore very important to plan treatment. We believe that CT should be performed as soon as possible, even on the basis of minor clinical and laboratory data.
Asunto(s)
Bazo/diagnóstico por imagen , Bazo/lesiones , Tomografía Computarizada por Rayos X , Heridas no Penetrantes/diagnóstico por imagen , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Thirty patients of both sexes (15 males and 15 females) with chronic renal failure who had under gone hemodialysis for 2-184 months (mean 45.1 months) were examined with conventional radiographs of the cervical spine and thin-layer CT of C4-C5-C6 to evaluate the radiographic patterns of destructive spondyloarthropathy. The radiographic patterns obtained with conventional and CT exams were compared with one another and with clinical (carpal tunnel syndrome) and biochemical data (alkaline phosphatase, parathormon, Ca, P, Ca/P, Al, beta 2-microglobulin). DSA (erosion and narrowing of the intervertebral space, collapse of the vertebral body and erosion of the vertebral plates) was recognized in 7 patients with conventional radiographs and in 11 patients with CT thanks to greater CT capabilities to recognize minimal osteolytic lesions of the vertebral body. All the patients with destructive spondyloarthropathy had personal and hemodialysis age higher than those without destructive spondyloarthropathy: 59.3 vs 57.7 years; 49 vs 39 months. Parathormon and alkaline phosphatase were increased while beta 2-microglobulin was normal. Only 2 patients with DSA had carpal tunnel syndrome. In conclusion, CT is a valuable technique for the diagnosis of destructive spondyloarthropathy but it must be performed only after conventional radiographs of the cervical spine or in the presence of clinical signs of destructive spondyloarthropathy (parathormon and beta 2-microglobulin increased, long-term hemodialysis).
Asunto(s)
Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/diagnóstico por imagen , Artropatías/diagnóstico por imagen , Diálisis Renal , Enfermedades de la Columna Vertebral/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
In this paper the authors report on a new technique--percutaneous transluminal laser angioplasty (PLR) which was performed on 9 patients with iliac and/or femoro-popliteal artery occlusion. All patients were males (mean age: 64.5 years) and had arterial occlusion (mean length: cm 12.5). PLR was performed with an argon laser (max power: 16 Watts). In 8 out of 9 patients (88.8%) a complete recanalization was obtained of the occluded arterial tract, without complications. In one case only (12.2%) there was an arterial wall perforation with unsatisfactory results. In our opinion, PLR has proven a simple methodology, which can be performed on any patient due to the very low incidence of severe complications and distal embolism. Moreover, PLR has quite low costs, and does not prevent eventual surgical/percutaneous interventions.
Asunto(s)
Angioplastia de Balón/métodos , Arteriopatías Oclusivas/terapia , Arteria Femoral , Terapia por Láser , Anciano , Angiografía , Angioplastia de Balón/instrumentación , Arteriopatías Oclusivas/diagnóstico por imagen , Arteriopatías Oclusivas/cirugía , Humanos , Arteria Ilíaca , Pierna/irrigación sanguínea , Masculino , Persona de Mediana Edad , Arteria PoplíteaRESUMEN
Cystic neoplasms of the pancreas are rare lesions. Following the Compagno-Oertel classification, we differentiated serous microcystic adenomas (SMA) from mucinous macrocystic adenomas/adenocarcinomas (MMA). The former are benign tumors with slow growth, composed by innumerable small and tiny cysts with central calcifications, resulting in a "honeycomb" pattern. They have a mixed US structure while CT densitometric values reflect a mixture of connective tissue and proteinaceous fluid. Postcontrast enhancement is frequently seen. MMA are potential (adenoma) or frankly (adenocarcinoma) malignant tumors. They appear as multilocular cystic masses containing septa and/or papillary bulges, with thickened walls. Both US and CT demonstrate their predominantly cystic character, and the eventual presence of excrescences. We report a series of 23 cases (6 SMA, 17 MMA) of cystic neoplasms of the pancreas studied during the past five years. A correct diagnosis of SMA was possible in all 6 cases, while MMA was correctly diagnosed in 17 out of 18 cases. There were no false negatives, and 1 false positive. All differential diagnoses are also discussed.
Asunto(s)
Quiste Pancreático/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Tomografía Computarizada por Rayos X , Ultrasonografía , Adenocarcinoma Mucinoso/diagnóstico , Adenoma/diagnóstico , Diagnóstico Diferencial , Reacciones Falso Negativas , Reacciones Falso Positivas , Estudios de Seguimiento , Humanos , Páncreas/diagnóstico por imagen , Páncreas/patología , Estudios RetrospectivosRESUMEN
Cholangiographically-enhanced CT scans were performed on nine patients with biliary obstruction or suspected pancreatic masses. The opacification of the biliary tree was obtained by slow infusion of 25 ml of cholangiographic contrast medium diluted in 75 ml of saline and administered 45 mins before the CT examination. Two separate CT sequences were obtained, one with cholangiographic contrast alone, the other with associated parenchymal enhancement. The tolerability of the overall procedure was very good. The measurement of the HU values of the biliary ducts showed a marked increase in bile density. These structures could easily be appreciated within the liver and in the porta hepatis; the pancreatic head and its relationships with the main bile duct were evident. The densitometric measurement of the liver parenchyma before and after contrast enhancement did not show any variation with respect to the standard HU values. Cholangiographically-enhanced CT proved to be useful for the diagnosis of biliary obstruction; it may also be a promising diagnostic tool for the evaluation of pancreatic masses.
Asunto(s)
Sistema Biliar/diagnóstico por imagen , Colangiografía/métodos , Páncreas/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Medios de Contraste/administración & dosificación , Humanos , Aumento de la Imagen/métodosAsunto(s)
Quistes/diagnóstico por imagen , Pericardio , Anciano , Femenino , Humanos , Tomografía Computarizada por Rayos XRESUMEN
The radiological features of one patient, entirely asymptomatic, with a paracardiac mass in the right lower lobe, are presented. Computed tomography (TC) evaluation of the chest has shown with remarkable accuracy a massive hiatal hernia, containing the whole stomach and fatty omental tissue. This case confirms TC validity as an accurate and non invasive method in differential diagnosis of chest radiological opacities and its utility to identify seat and composition of diaphragmatic hernias.