Stefano Profili

Percutaneous treatment of hepatic cysts by aspiration and sclerotherapy

We treated 35 patients who had hepatic cysts (30 congenital cysts, 5 hydatid cysts) with percutaneous puncture and sclerotherapy. After puncture and drainage of the cyst, a 95% alcohol solution was instilled as sclerosing agent into the cystic cavity. In all the patients, cyst puncture and drainage was successful. Follow-up in all cases was at least 12 months. In three uncooperative patients, cysts recurred due to incomplete sclerosis of the lining epithelium of the cyst wall. No major complications were encountered in all cases. All congenital cysts were treated on an outpatient basis. Patients with hydatid cyst were hospitalized for 48 h after puncture and aspiration. In our opinion, percutaneous drainage and sclerosis of congenital hepatic cysts can be considered an effective alternative to surgical treatment.

Combined Biliary and Duodenal Stenting for Palliation of Pancreatic Cancer

The aim of this case report was to evaluate the usefulness of combined biliary and duodenal stenting in the palliation of pancreatic cancer. We report a series of 4 consecutive patients (2 men and 2 women, mean age 58.5 years, range 38–77 years) who underwent combined biliary and duodenal stenting in our department between March 2000 and April 2001. All patients had cancer of the head of the pancreas causing stricture of the common bile duct and second portion of the duodenum. Biliary and duodenal stents were successfully positioned, with relief of symptoms in all cases. No early complications were observed, except for a transient increase in serum lipase and amylase in one case. Mean follow‐up was 7.5 months (range 5–14 months). One patient presenting recurrence of vomiting after 4 months because of tumour overgrowth at the distal edge of the prosthesis was successfully treated by insertion of a partially overlapping second coaxial stent. Combined biliary and duodenal stenting for the palliation of pancreatic cancer was performed safely and successfully. Stents allowed effective re‐canalization of the biliary tract and duodenum, relieving both jaundice and vomiting. This procedure should be considered as an alternative to palliative surgery, especially in critically ill patients.

Palliative Airway Stenting Performed Under Radiological Guidance and Local Anesthesia

PurposeTo assess the effectiveness of airway stenting performed exclusively under radiological guidance for the palliation of malignant tracheobronchial strictures.MethodsWe report our experience in 16 patients with malignant tracheobronchial stricture treated by insertion of 20 Ultraflex self-expandable metal stents performed under fluoroscopic guidance only. Three patients presented dysphagia grade IV due to esophageal malignant infiltration; they therefore underwent combined airway and esophageal stenting. All the procedures were performed under conscious sedation in the radiological room; average procedure time was around 10 min, but the airway impediment never lasted more than 40 sec.ResultsWe obtained an overall technical success in 16 cases (100%) and clinical success in 14 patients (88%). All prostheses were successfully placed without procedural complications. Rapid clinical improvement with symptom relief and normalization of respiratory function was obtained in 14 cases. Two patients died within 48 hr from causes unrelated to stent placement. Two cases (13%) of migration were observed; they were successfully treated with another stent. Tumor overgrowth developed in other 2 patients (13%); however, no further treatment was possible because of extensive laryngeal infiltration.ConclusionsTracheobronchial recanalization with self-expandable metal stents is a safe and effective palliative treatment for malignant strictures. Airway stenting performed exclusively under fluoroscopic view was rapid and well tolerated.

A Rare Case of Primary Actinomycosis of the Breast Caused by Actinomyces viscosus: Diagnosis by Fine-needle Aspiration Cytology under Ultrasound Guidance

Abstract:  We report the case of a 27‐year‐old woman with primary actinomycosis of the breast. Diagnosis was established by culture examination of specimen recovered by fine‐needle aspiration cytology (FNAC) under ultrasound guidance. To our knowledge, this is the first description in the literature of a case of primary actinomycosis of the breast caused by Actinomyces viscosus. Twenty‐nine previous cases of primary actinomycosis of the breast have been published, but these were caused by the more common species Actinomyces israelii. Targeted antibiotic therapy did not ameliorate the condition, thus drainage and excision of the mass were carried out. No other medical therapy was administered. Six years after surgery, no recurrence has been observed on both ultrasonographic and mammographic examinations. 

Impact of Age on Long-Term Complications after Biliopancreatic Diversion

Background: The aim of the study is to evaluate the importance of age on the mid- and long-term results and complications after biliopancreatic diversion (BPD). Methods: Our study comprises 132 morbidly obese patients who underwent Scopinaro BPD from February 1995 to April 2001, with follow-up from 24 to 96 months. The patients, 53 males (40%) and 79 females (60%), with mean preoperative BMI 50.2 (35.4-81.5), and mean age 42 (20-65), were divided in 4 groups. Group A age 20-35, 43 patients; Group B age 36-45, 33 patients; Group C age 46-55, 31 patients and Group D age >55, 25 patients. Incidence of long-term specific complications after BPD were analyzed, including protein malnutrition, reversals, anastomotic ulcer, and incisional hernia. Results: Mean postoperative BMI was similar in all Groups. After 60 months the following BMI values were observed. Group A 30.8, Group B 34.9, Group C 35.9, Group D 32. Incidence of long-term complications were not significantly different (χ2) in the 4 Groups, and were respectively: protein malnutrition 6.9%, 12.1%, 6.4%, 16.0%; anastomotic ulcer 11.6%, 9%, 6.4%, 16.0%; reversal 2.3%, 9.0%, 1.32%, 8.0%; ventral hernia 34.8%, 45.4%, 54.8%, 32.0%. Conclusions: From the preliminary results, it appeared that the incidence of the complications was higher in group D (>55 years old), whereas group C (46-55 years old) showed a lower complication rate. However, the prevalence of complications in all groups was not statistically different on χ2 analysis. No age limit for bariatric surgery could be determined from the age ranges studied.

Mediastinal abscess and esophageal stricture following voice prosthesis insertion.

The use of a tracheo-esophageal voice prosthesis is a well-established procedure to restore the voice in total laryngectomees. The insertion of the prosthesis is not a risk-free procedure, various complications having been reported especially in irradiated patients. Here described is a case of an esophageal rupture after secondary tracheo-esophageal puncture with mediastinal abscess in a patient previously treated with pharyngo-laryngectomy and subsequent radiotherapy for a left pyriform sinus carcinoma, which required immediate surgical drainage through a left cervical approach. Few weeks after surgical drainage an esophageal stricture at the site of the rupture developed, which was only temporarily resolved after the insertion of biodegradable esophageal stents, followed by re-stenosis once the reabsorption of the stent took place.

Granular cell tumor of the breast.

Granular cell tumor of the breast is a rare, usually benign tumor that is encountered in women 30–50 years old, usually presenting as a palpable, painless mass. Ultrasonographic and mammographic findings are not specific for this tumor and histology is mandatory for certain diagnosis and to exclude malignancy.

Cardiocutaneous fistula in a delayed iathrogenic ventricular perforation of the heart: computed tomographic and magnetic resonance imaging findings.

Cardiac iathrogenic lesions can occur during diagnostic or therapeutic procedures. Resistance of the heart to an injury may cause a delay from the traumatic event to onset of the symptomatology or to heart rupture. We describe a rare case cardiac perforation with delayed rupture of the heart in a patient previously submitted to radiation therapy for breast cancer. Cardiocutaneous fistula at the cross-sectional computed tomographic and magnetic resonance imaging findings has not been previously reported, to our knowledge.

Gastroduodenal stenting: is still useful in the treatment of malignant obstruction?

It was carried out as an epidemiological retrospective study in the Radiology Department of the University of Sassari, Italy. Patients with an inoperable neoplastic GDOO were consecutively recruited from 2004 to 2014; they were referred from all medical and surgical wards of three general hospitals located in the province of Sassari, Italy. Patients admitted in the Radiology Department were managed by a multi-specialty and multi-disciplinary team, involving specialists in internal medicine, surgery, anesthesia, endoscopy, interventional radiology, nursing, nutrition. They assessed nutritional status, World Health Organization (WHO) performance status, potential comorbidities, and blood cell counts and chemistry [6, 7]. An abdominal X-ray performed by Philips Omnidiagnost Elevation X-Ray and using contrast agent (Gastrografin, Bayer) to identify site, extension and obstruction size. The WallFlexDuodenal Stent (uncoated selfexpansible stent, Boston Scientific), advanced over a NitrexGuidewires 0.035 inch Straight Tip, 400 cm (Covidien) was used to by-pass obstruction. Its placement was carried out under fluoroscopic guidance; however, it could be associated with endoscopic guidance in cases of poor WHO performance status or stenosis distal to Treitz ligament. Before the procedure, patients were intravenous exposed to the benzodiazepine. Data were retrieved from the medical files using an ad-hoc electronic form, including demographic, clinical,

Operated Large Bowel

Surgery of the large bowel includes many different intervention performed in the treatment of a wide spectrum of pathologies. Follow up imaging is needed particularly in patients with neoplastic and flogistic diseases. Contrast CT colonography is an emerging test which allows to obtain during a single examination an accurate assessment of large bowel wall, anastomotic and perianastomotic area, abdominal organs, nodes, and peritoneal cavity. In this chapter the most frequent normal and pathologic Contrast CT colonography pattern are showed.