Ernesto Mazza | Università degli Studi di Firenze (University of Florence) (original) (raw)
Papers by Ernesto Mazza
La Chirurgia degli organi di movimento
Osteoid osteoma is a common benign lesion, that occurs in children and young adults. The authors ... more Osteoid osteoma is a common benign lesion, that occurs in children and young adults. The authors report the observation of a multifocal lesion which is infrequently reported in the literature. S.A., a 10-year-old female came to our observation complaining of spontaneous pain in her right hip and cruralgia radiating to the homolateral knee over the last 6 months; the symptoms, which increased during the night, were relieved by treatment with NSAIDS. Clinical examination and imaging studies confirmed a diagnosis of osteoid osteoma with a double nidus; the lesion was treated by CT-guided thermo-ablation with radiofrequency under general anaesthesia. Complete regression of symptoms was observed at 2-year follow-up.
La Radiologia medica, 1992
Case Reports, 2012
The authors present a case of a gastroduodenal artery pseudoaneurysm in a patient with a medical ... more The authors present a case of a gastroduodenal artery pseudoaneurysm in a patient with a medical history of pancreatic surgery. The lesion was found and evaluated by ultrasound, CT-angiography and then treated with trans-catheter embolisation. This mini-invasive approach led to a complete resolution of the lesion.
Tumori
Pancreatic carcinoma often involves the head of the pancreas and obstructive jaundice is its earl... more Pancreatic carcinoma often involves the head of the pancreas and obstructive jaundice is its earliest sign. It sometimes extends to celiac plexus and duodenum causing pain and bowel obstruction respectively. Only 20% of cases are totally resectable (stage I) at the time of diagnosis. Palliative treatment is the only available therapeutic option when the tumor extends surrounding organs or has given lymphatic metastases (stage II, III, IV). The aim of this study is to evaluate effectiveness of interventional radiology procedures on unresectable cancer palliative treatment. Between Jan 90 and Sep 98, 195 patients with unresectable pancreatic carcinoma received percutaneous treatments. They were 104 males and 91 females with mean age of 74 years (range, 48-95). One hundred eighty four patients underwent biliary drainage, six patients underwent celiac plexus block, two patients were treated by bowel stenting. Two patients received both biliary and bowel stents, one patient underwent biliary drainage and celiac plexus block. Jaundice treatment was performed by placement of drainage catheters in 48 patients, polymeric endoprostheses in 58 and metallic stents in 77 (67 Wallstents). Biliary drainage was successful in all cases obtaining appreciable bilirubin serum levels reduction and jaundice regression in 175 patients (95%). In 44 patients Wallstents were placed during a single PTC session time ("one step" technique). In 21 cases (11%) peri-procedural complications occurred. Follow-up related to 85 patients shows survival rate covered between 30 and 570 days (mean, 142). Best survival values occurred in patients who underwent "one step" technique. Celiac plexus block was successful in 5/7 cases (71%) with no complications, total pain relief and withdrawal of pharmacological treatment. Bowel stenting achieved complete recanalization of intestinal loop in 2 cases but showed troubles related to management of these patients. In patients with unresectable pancreatic carcinoma palliation is the only therapeutic option and has the purpose to achieve biliary tree decompression and eliminate jaundice associated symptoms, improving quality of life and reducing hospitalization. Jaundice relief is reachable by surgical, endoscopic or percutaneous approach. Surgical palliation is characterized by disadvantageous cost-effectiveness rate. Endoscopic and percutaneous palliations are alternative, although, in selected patients, percutaneous Wallstents placement by one step technique is perhaps the most successful procedure, showing high rate of technical outcome with low complications and short time spent in hospital. Celiac plexus block under CT guidance constitutes a reliable method for management of pain. At present bowel stricture treatment is surgical.
HPB
Background Carcinoid tumours of the extrahepatic biliary tree are exceedingly rare. We report a c... more Background Carcinoid tumours of the extrahepatic biliary tree are exceedingly rare. We report a case of primary carcinoid tumour arising in the distal portion of the common bile duct. Case outlineA 30-year-old man was admitted with watery diarrhoea and symptoms of biliary obstruction. Abdominal ultrasound scan showed a normal gallbladder without stones, mild dilatation of the intra- and extrahepatic biliary tree and a 2 cm solid lesion in the head of pancreas compressing the distal common bile duct. Computed tomography confirmed these findings and showed that the tumour was hypervascular. Gastrointestinal hormone screening showed an increase in plasma serotonin. The patient underwent a standard pylorus-preserving proximal pancreatoduodenectomy (PPPD). ResultsPathological examination showed a neuroendocrine tumour (carcinoid) of the distal bile duct. The postoperative plasma serotonin decreased to normal levels. One year later the patient is well without evidence of disease. Discussi...
Digestive and Liver Disease, 2015
This Position Paper contains clinically oriented guidelines by the Italian Association for the St... more This Position Paper contains clinically oriented guidelines by the Italian Association for the Study of the Pancreas (AISP) for the diagnosis and treatment of severe acute pancreatitis. The statements were formulated by three working groups of experts who searched and analysed the most recent literature; a consensus process was then performed using a modified Delphi procedure. The statements provide recommendations on the most appropriate definition of the complications of severe acute pancreatitis, the diagnostic approach and the timing of conservative as well as interventional endoscopic, radiological and surgical treatments.
Interventional Neuroradiology of the Spine, 2013
Journal of Surgical Oncology, 2004
Pancreatic cancer is still predominantly diagnosed in advanced stages, and 85%-90% of patients ar... more Pancreatic cancer is still predominantly diagnosed in advanced stages, and 85%-90% of patients are not eligible for surgery at diagnosis. This is mainly due to the great difficulty in detecting the tumour at an early stage and presently no satisfactory results have been obtained to overcome this problem. Studies on molecular genetic profile of pancreatic cancer may represent an important approach. This study was focused on the mutations of p53 and DPC4 detectable in the bile of patients with histologically proven pancreatic cancers. We analysed specimens of bile collected through percutaneous transhepatic biliary catheters, placed to treat malignant biliary obstruction in 25 patients with pancreatic adenocarcinoma. A percentage of mutation was obtained of 43 % for the microsatellite D17S945 (p53), 54% and 50 % for D18S46 and D18S474 (DPC4), respectively. The percentage of amplification was 67%, 93,6%, and 80%. We consider the results encouraging enough to decide to enlarge the number of patients examined. The aim is to determine if a test for DPC4 and p53 mutations is eligible for introduction in clinical routine use. More sets of samples are required to satisfactorily answer this question.
Archives of Surgery, 1997
The incidental discovery of an adrenal mass poses the problem of distinguishing between the frequ... more The incidental discovery of an adrenal mass poses the problem of distinguishing between the frequent benign masses and the infrequent malignant ones that require surgery. Univocal guidelines to approach this problem are unavailable. To perform a survey of the clinical management of incidentally discovered adrenal masses (ie, adrenal incidentalomas). A multicentric retrospective analysis of hospital medical records of adrenal incidentalomas diagnosed during a 5-year period; the medical records were scrutinized for demographic data and clinical details by means of a specifically tailored questionnaire. The major surgical and medical centers of Piedmont, a northern Italian region with approximately 4 million inhabitants. The recruitment pattern of these centers was unselected. The definition of adrenal incidentaloma was limited to patients with a physical examination and a clinical history unindicative of adrenal disease. Exclusion criteria also included hypertension of suspected endocrine origin and a history of neoplasms known to metastasize frequently in the adrenal glands. Two hundred twenty-four medical records were collected, and 210 were analyzed (14 excluded a posteriori). Most patients were in their 50s and 60s, and women were predominantly affected. The frequency of adrenocortical cancer was 13% among patients operated on. The tumor diameter was highly correlated with the risk of cancer; a cutoff at 5 cm had a sensitivity of 93% with a specificity of 64% in discriminating between benign and malignant cortical lesions. The occurrence of adrenocortical carcinoma among adrenal incidentalomas is not rare. The evaluation of the mass size is a simple and effective method for selecting patients at risk for cancer. The indication for surgery of masses larger than 5 cm, or of masses of any diameter that have suspicious imaging characteristics, limits unnecessary operations and costs.
PURPOSE To assess the feasibility of multiple cross-stent-positioning operated through one percut... more PURPOSE To assess the feasibility of multiple cross-stent-positioning operated through one percutaneous access in patient with malignant biliary obstruction of hepatic hilum and compare with conventional positioning stent in malignant biliary obstruction of hepatic hilum. METHOD AND MATERIALS From January 1998 to December 2003, 396 patients with malignant biliary obstruction underwent percutaneous biliary drainage with one-step positioning of 679 wallstents.In 76 patients with malignant biliary obstruction of the hilum, drainage of biliary tree was obtained with one percutaneous access through which multiple stent deployment was executed by a cross-positioning technique. The first self-expandable endoprosthesis was positioned in the common bile duct. Thereafter a balloon catheter was inserted along a previously introduced guide wire to dilate the mesh of the stent. After removing the catheter, a second stent was implanted through the dilated wall of the fist stent, across the hilum....
PURPOSE Postoperative pancreatic fistula (PF) is a complication after abdominal trauma, partial p... more PURPOSE Postoperative pancreatic fistula (PF) is a complication after abdominal trauma, partial pancreatectomy, pancreatic biopsy, or acute/chronic pancreatitis and it can lead to prolonged hospital stay, increased costs, and mortality. Both internal and external pancreatic fistulas result from leakage of pancreatic juice from a pancreatic duct. External PF extends from the pancreas or peripancreatic fluid collection to the skin surface. Treatment options for PF can be conservative, endoscopic, percutaneous, or surgical. Endoscopic treatment is the next step if conservative measures fail to heal PF in few weeks. Surgical treatment is reserved for patients who have failed all other treatments (success rate is 90-92% despite a mortality of 6-9%). We present a percutaneous radiologically guided technique of intractable (with other techniques) external pancreatic fistula. METHOD AND MATERIALS From June 1998 to September 2008 we treated 10 patients (7 men and 3 women, mean age 61 yr, ran...
PURPOSE Evaluating effectiveness, survival rate and complications of percutaneous CT-guided radio... more PURPOSE Evaluating effectiveness, survival rate and complications of percutaneous CT-guided radiofrequency ablation in patients affected by NSCLC with nodules smaller than 3 cm, ineligible for surgery or with recurrent disease. METHOD AND MATERIALS Between 2003 and 2008 we performed 37 RFAs under CT guidance in 35 pts (16 females and 19 males; mean age 76.5 years; range 49-87 years) affected by NSCLC. Pts were considered non-surgical candidates due to high ASA score, recurrent disease after lobectomy or explicit refusal of surgery. All pts were affected by NSCLC with 3 or less lesions per hemithorax, nodule size smaller than 3 cm (mean size 1,7 cm; range 0,6-3 cm) without invasion of the hilum or mediastinum (evaluated with CT and PET). 30 pts, ineligible or refusing surgery, received RFA as first treatment, 5 pts had previous surgery (3 lobectomy and 2 pneumonectomy). On the basis of follow-up reports, we estimated survival rate and disease-free interval. RESULTS In all cases we ac...
PURPOSE To evaluate the outcome and complications of CT-guided percutaneous drainage of antibioti... more PURPOSE To evaluate the outcome and complications of CT-guided percutaneous drainage of antibiotic therapy resistant lung abscesses. METHOD AND MATERIALS From December 2000 to December 2004, 13 patients (age 26-76 years) with bacterial lung abscess, resistant to antibiotic therapy, underwent CT-guided drainage. In all cases cytological diagnosis was confirmed by CT-guided fine needle aspiration. For the drainage we used: in 5 patients a 21 G Chiba needle, in 2 patients a 18 G Chiba needle, in 6 patients a 14 Fr catheter which was positioned mean Seldinger technique. CT scans were obtained in all patients before, during and after the drainage. CT was repeated every month until complete resolution of the abscess was observed. All patients received antibiotic therapy based on the antibiogram obtained after aspiration. RESULTS Complete resolution of the lesions was obtained in all cases. The mean period of hospitalization was 5 days. Drainages were left in place for 7 days. Clinical res...
PURPOSE To estimate the practicability of simultaneous Percutaneous RadioFrequency ThermoAblation... more PURPOSE To estimate the practicability of simultaneous Percutaneous RadioFrequency ThermoAblation (PRFTA) of hepatic and pulmonary metastases in a single session procedure. METHOD AND MATERIALS From July 2002 to February 2004, 65 PRFTA were performed in 25 patients (age range 46-82; mean age 64) affected by hepatic and pulmonary metastases from colon-rectal carcinoma. Of the 65 nodules 36 were pulmonary and 29 hepatic. Nodules size ranged from 1 to 3 cm. All pulmonary PRFTA were carried out under CT guidance whereas hepatic PRFTA were executed under CT guidance in 13 cases and US guidance in 16 casesBoth hepatic and pulmonary lesions were treated on a single session procedure by Radionics RF Generator System applied for 12 minute and either single probes with 2 to 3-cm unprotected tip or cluster probes positioned at the centre of lesions and cooled by a peristaltic pump. RESULTS Patients were hospitalized for 1 to 5 days; average 2.3 days. PRFTA resulted in complete necrosis in all ...
PURPOSE To evaluate the effectiveness of percutaneous laser diode disc decompression (PL3D) in th... more PURPOSE To evaluate the effectiveness of percutaneous laser diode disc decompression (PL3D) in the treatment of lumbosacral disc herniation. METHOD AND MATERIALS From September 2002 to February 2006 we performed 842 percutaneous laser diode disc decompressions in 708 patients (age 16-84, mean age 42) with relevant symptoms resistant to medical therapy. We used fluoroscopic guidance in 553 patients, CT guidance in 143 and fluoro-CT guidance in 12. The level of disc decompression was L2-L3 in 45 cases, L3-L4 in 96, L4-L5 in 395, L5-S1 in 306. In 48 cases the PL3D was performed after unsuccessful microsurgical approach. The access to the intervertebral disc was performed with a 21G Chiba needle of 100 or 150 mm. The needle was introduced either with an oblique or a paramedian transdural access. In all cases a multidiode laser with a wavelenght of 980 nm was used. The clinical success was evaluated with the MacNab criteria. RESULTS After a mean follow-up of 21 months 618 patients (91%) ...
PURPOSE To evaluate the clinical outcome of Percutaneous Laser Disc Decompression using Multidiod... more PURPOSE To evaluate the clinical outcome of Percutaneous Laser Disc Decompression using Multidiode Laser System under CT guidance in patients with lumbar disc herniation. METHOD AND MATERIALS From December 2004 to March 2005, 51 patients aged 22 to 86 years (mean age 56 years) with lumbar disc herniation were treated with percutaneous laser disc decompression. All procedures were performed in prone decubitus and under local anaesthesia, using only CT guidance. All patients received chemoprophylaxis with cephazolin. A 21G Chiba needle of 100 or 150 mm was positioned into the nucleus pulposus transfixing the hernia. The needle was introduced either with an oblique or a paramedian transdural access. In all cases a multidiode laser with a wavelenght of 980 nm was used. The clinical outcome was evaluated with MacNab criteria and a visual-analogue scale (VAS). RESULTS All procedures were performed in day hospital regimen. Following the MacNab criteria, of 51 patients treated with PL3D und...
PURPOSE Evaluating effectiveness of percutaneous drainage of bacterial and fungal antibiotic resi... more PURPOSE Evaluating effectiveness of percutaneous drainage of bacterial and fungal antibiotic resistant lung abscesses. METHOD AND MATERIALS From December 2000 to December 2008, 23 patients (age 26-81 years) with bacterial and fungal lung abscesses, resistant to antibiotic therapy, were treated with percutaneous CT-guided drainage. Bacterial or fungal abscess diagnosis was confirmed with fine needle aspiration. In 12 patients needle aspiration was effective for drainage, using a 21G and 18G Chiba needle in 7 and 11 patients respectively. In 11 patient 14 Fr catheter positioning was necessary. CT scans were obtained in all patients before, during and after the drainage. Clinical evaluation of abscess resolution was achieved with CT scans. All patients received antibiotic therapy based on the antibiogram obtained after aspiration or empirical basis. RESULTS Complete resolution of the lesions was obtained in all cases. The mean period of hospitalization was 4 days. Drainages were left i...
La Chirurgia degli organi di movimento
Osteoid osteoma is a common benign lesion, that occurs in children and young adults. The authors ... more Osteoid osteoma is a common benign lesion, that occurs in children and young adults. The authors report the observation of a multifocal lesion which is infrequently reported in the literature. S.A., a 10-year-old female came to our observation complaining of spontaneous pain in her right hip and cruralgia radiating to the homolateral knee over the last 6 months; the symptoms, which increased during the night, were relieved by treatment with NSAIDS. Clinical examination and imaging studies confirmed a diagnosis of osteoid osteoma with a double nidus; the lesion was treated by CT-guided thermo-ablation with radiofrequency under general anaesthesia. Complete regression of symptoms was observed at 2-year follow-up.
La Radiologia medica, 1992
Case Reports, 2012
The authors present a case of a gastroduodenal artery pseudoaneurysm in a patient with a medical ... more The authors present a case of a gastroduodenal artery pseudoaneurysm in a patient with a medical history of pancreatic surgery. The lesion was found and evaluated by ultrasound, CT-angiography and then treated with trans-catheter embolisation. This mini-invasive approach led to a complete resolution of the lesion.
Tumori
Pancreatic carcinoma often involves the head of the pancreas and obstructive jaundice is its earl... more Pancreatic carcinoma often involves the head of the pancreas and obstructive jaundice is its earliest sign. It sometimes extends to celiac plexus and duodenum causing pain and bowel obstruction respectively. Only 20% of cases are totally resectable (stage I) at the time of diagnosis. Palliative treatment is the only available therapeutic option when the tumor extends surrounding organs or has given lymphatic metastases (stage II, III, IV). The aim of this study is to evaluate effectiveness of interventional radiology procedures on unresectable cancer palliative treatment. Between Jan 90 and Sep 98, 195 patients with unresectable pancreatic carcinoma received percutaneous treatments. They were 104 males and 91 females with mean age of 74 years (range, 48-95). One hundred eighty four patients underwent biliary drainage, six patients underwent celiac plexus block, two patients were treated by bowel stenting. Two patients received both biliary and bowel stents, one patient underwent biliary drainage and celiac plexus block. Jaundice treatment was performed by placement of drainage catheters in 48 patients, polymeric endoprostheses in 58 and metallic stents in 77 (67 Wallstents). Biliary drainage was successful in all cases obtaining appreciable bilirubin serum levels reduction and jaundice regression in 175 patients (95%). In 44 patients Wallstents were placed during a single PTC session time ("one step" technique). In 21 cases (11%) peri-procedural complications occurred. Follow-up related to 85 patients shows survival rate covered between 30 and 570 days (mean, 142). Best survival values occurred in patients who underwent "one step" technique. Celiac plexus block was successful in 5/7 cases (71%) with no complications, total pain relief and withdrawal of pharmacological treatment. Bowel stenting achieved complete recanalization of intestinal loop in 2 cases but showed troubles related to management of these patients. In patients with unresectable pancreatic carcinoma palliation is the only therapeutic option and has the purpose to achieve biliary tree decompression and eliminate jaundice associated symptoms, improving quality of life and reducing hospitalization. Jaundice relief is reachable by surgical, endoscopic or percutaneous approach. Surgical palliation is characterized by disadvantageous cost-effectiveness rate. Endoscopic and percutaneous palliations are alternative, although, in selected patients, percutaneous Wallstents placement by one step technique is perhaps the most successful procedure, showing high rate of technical outcome with low complications and short time spent in hospital. Celiac plexus block under CT guidance constitutes a reliable method for management of pain. At present bowel stricture treatment is surgical.
HPB
Background Carcinoid tumours of the extrahepatic biliary tree are exceedingly rare. We report a c... more Background Carcinoid tumours of the extrahepatic biliary tree are exceedingly rare. We report a case of primary carcinoid tumour arising in the distal portion of the common bile duct. Case outlineA 30-year-old man was admitted with watery diarrhoea and symptoms of biliary obstruction. Abdominal ultrasound scan showed a normal gallbladder without stones, mild dilatation of the intra- and extrahepatic biliary tree and a 2 cm solid lesion in the head of pancreas compressing the distal common bile duct. Computed tomography confirmed these findings and showed that the tumour was hypervascular. Gastrointestinal hormone screening showed an increase in plasma serotonin. The patient underwent a standard pylorus-preserving proximal pancreatoduodenectomy (PPPD). ResultsPathological examination showed a neuroendocrine tumour (carcinoid) of the distal bile duct. The postoperative plasma serotonin decreased to normal levels. One year later the patient is well without evidence of disease. Discussi...
Digestive and Liver Disease, 2015
This Position Paper contains clinically oriented guidelines by the Italian Association for the St... more This Position Paper contains clinically oriented guidelines by the Italian Association for the Study of the Pancreas (AISP) for the diagnosis and treatment of severe acute pancreatitis. The statements were formulated by three working groups of experts who searched and analysed the most recent literature; a consensus process was then performed using a modified Delphi procedure. The statements provide recommendations on the most appropriate definition of the complications of severe acute pancreatitis, the diagnostic approach and the timing of conservative as well as interventional endoscopic, radiological and surgical treatments.
Interventional Neuroradiology of the Spine, 2013
Journal of Surgical Oncology, 2004
Pancreatic cancer is still predominantly diagnosed in advanced stages, and 85%-90% of patients ar... more Pancreatic cancer is still predominantly diagnosed in advanced stages, and 85%-90% of patients are not eligible for surgery at diagnosis. This is mainly due to the great difficulty in detecting the tumour at an early stage and presently no satisfactory results have been obtained to overcome this problem. Studies on molecular genetic profile of pancreatic cancer may represent an important approach. This study was focused on the mutations of p53 and DPC4 detectable in the bile of patients with histologically proven pancreatic cancers. We analysed specimens of bile collected through percutaneous transhepatic biliary catheters, placed to treat malignant biliary obstruction in 25 patients with pancreatic adenocarcinoma. A percentage of mutation was obtained of 43 % for the microsatellite D17S945 (p53), 54% and 50 % for D18S46 and D18S474 (DPC4), respectively. The percentage of amplification was 67%, 93,6%, and 80%. We consider the results encouraging enough to decide to enlarge the number of patients examined. The aim is to determine if a test for DPC4 and p53 mutations is eligible for introduction in clinical routine use. More sets of samples are required to satisfactorily answer this question.
Archives of Surgery, 1997
The incidental discovery of an adrenal mass poses the problem of distinguishing between the frequ... more The incidental discovery of an adrenal mass poses the problem of distinguishing between the frequent benign masses and the infrequent malignant ones that require surgery. Univocal guidelines to approach this problem are unavailable. To perform a survey of the clinical management of incidentally discovered adrenal masses (ie, adrenal incidentalomas). A multicentric retrospective analysis of hospital medical records of adrenal incidentalomas diagnosed during a 5-year period; the medical records were scrutinized for demographic data and clinical details by means of a specifically tailored questionnaire. The major surgical and medical centers of Piedmont, a northern Italian region with approximately 4 million inhabitants. The recruitment pattern of these centers was unselected. The definition of adrenal incidentaloma was limited to patients with a physical examination and a clinical history unindicative of adrenal disease. Exclusion criteria also included hypertension of suspected endocrine origin and a history of neoplasms known to metastasize frequently in the adrenal glands. Two hundred twenty-four medical records were collected, and 210 were analyzed (14 excluded a posteriori). Most patients were in their 50s and 60s, and women were predominantly affected. The frequency of adrenocortical cancer was 13% among patients operated on. The tumor diameter was highly correlated with the risk of cancer; a cutoff at 5 cm had a sensitivity of 93% with a specificity of 64% in discriminating between benign and malignant cortical lesions. The occurrence of adrenocortical carcinoma among adrenal incidentalomas is not rare. The evaluation of the mass size is a simple and effective method for selecting patients at risk for cancer. The indication for surgery of masses larger than 5 cm, or of masses of any diameter that have suspicious imaging characteristics, limits unnecessary operations and costs.
PURPOSE To assess the feasibility of multiple cross-stent-positioning operated through one percut... more PURPOSE To assess the feasibility of multiple cross-stent-positioning operated through one percutaneous access in patient with malignant biliary obstruction of hepatic hilum and compare with conventional positioning stent in malignant biliary obstruction of hepatic hilum. METHOD AND MATERIALS From January 1998 to December 2003, 396 patients with malignant biliary obstruction underwent percutaneous biliary drainage with one-step positioning of 679 wallstents.In 76 patients with malignant biliary obstruction of the hilum, drainage of biliary tree was obtained with one percutaneous access through which multiple stent deployment was executed by a cross-positioning technique. The first self-expandable endoprosthesis was positioned in the common bile duct. Thereafter a balloon catheter was inserted along a previously introduced guide wire to dilate the mesh of the stent. After removing the catheter, a second stent was implanted through the dilated wall of the fist stent, across the hilum....
PURPOSE Postoperative pancreatic fistula (PF) is a complication after abdominal trauma, partial p... more PURPOSE Postoperative pancreatic fistula (PF) is a complication after abdominal trauma, partial pancreatectomy, pancreatic biopsy, or acute/chronic pancreatitis and it can lead to prolonged hospital stay, increased costs, and mortality. Both internal and external pancreatic fistulas result from leakage of pancreatic juice from a pancreatic duct. External PF extends from the pancreas or peripancreatic fluid collection to the skin surface. Treatment options for PF can be conservative, endoscopic, percutaneous, or surgical. Endoscopic treatment is the next step if conservative measures fail to heal PF in few weeks. Surgical treatment is reserved for patients who have failed all other treatments (success rate is 90-92% despite a mortality of 6-9%). We present a percutaneous radiologically guided technique of intractable (with other techniques) external pancreatic fistula. METHOD AND MATERIALS From June 1998 to September 2008 we treated 10 patients (7 men and 3 women, mean age 61 yr, ran...
PURPOSE Evaluating effectiveness, survival rate and complications of percutaneous CT-guided radio... more PURPOSE Evaluating effectiveness, survival rate and complications of percutaneous CT-guided radiofrequency ablation in patients affected by NSCLC with nodules smaller than 3 cm, ineligible for surgery or with recurrent disease. METHOD AND MATERIALS Between 2003 and 2008 we performed 37 RFAs under CT guidance in 35 pts (16 females and 19 males; mean age 76.5 years; range 49-87 years) affected by NSCLC. Pts were considered non-surgical candidates due to high ASA score, recurrent disease after lobectomy or explicit refusal of surgery. All pts were affected by NSCLC with 3 or less lesions per hemithorax, nodule size smaller than 3 cm (mean size 1,7 cm; range 0,6-3 cm) without invasion of the hilum or mediastinum (evaluated with CT and PET). 30 pts, ineligible or refusing surgery, received RFA as first treatment, 5 pts had previous surgery (3 lobectomy and 2 pneumonectomy). On the basis of follow-up reports, we estimated survival rate and disease-free interval. RESULTS In all cases we ac...
PURPOSE To evaluate the outcome and complications of CT-guided percutaneous drainage of antibioti... more PURPOSE To evaluate the outcome and complications of CT-guided percutaneous drainage of antibiotic therapy resistant lung abscesses. METHOD AND MATERIALS From December 2000 to December 2004, 13 patients (age 26-76 years) with bacterial lung abscess, resistant to antibiotic therapy, underwent CT-guided drainage. In all cases cytological diagnosis was confirmed by CT-guided fine needle aspiration. For the drainage we used: in 5 patients a 21 G Chiba needle, in 2 patients a 18 G Chiba needle, in 6 patients a 14 Fr catheter which was positioned mean Seldinger technique. CT scans were obtained in all patients before, during and after the drainage. CT was repeated every month until complete resolution of the abscess was observed. All patients received antibiotic therapy based on the antibiogram obtained after aspiration. RESULTS Complete resolution of the lesions was obtained in all cases. The mean period of hospitalization was 5 days. Drainages were left in place for 7 days. Clinical res...
PURPOSE To estimate the practicability of simultaneous Percutaneous RadioFrequency ThermoAblation... more PURPOSE To estimate the practicability of simultaneous Percutaneous RadioFrequency ThermoAblation (PRFTA) of hepatic and pulmonary metastases in a single session procedure. METHOD AND MATERIALS From July 2002 to February 2004, 65 PRFTA were performed in 25 patients (age range 46-82; mean age 64) affected by hepatic and pulmonary metastases from colon-rectal carcinoma. Of the 65 nodules 36 were pulmonary and 29 hepatic. Nodules size ranged from 1 to 3 cm. All pulmonary PRFTA were carried out under CT guidance whereas hepatic PRFTA were executed under CT guidance in 13 cases and US guidance in 16 casesBoth hepatic and pulmonary lesions were treated on a single session procedure by Radionics RF Generator System applied for 12 minute and either single probes with 2 to 3-cm unprotected tip or cluster probes positioned at the centre of lesions and cooled by a peristaltic pump. RESULTS Patients were hospitalized for 1 to 5 days; average 2.3 days. PRFTA resulted in complete necrosis in all ...
PURPOSE To evaluate the effectiveness of percutaneous laser diode disc decompression (PL3D) in th... more PURPOSE To evaluate the effectiveness of percutaneous laser diode disc decompression (PL3D) in the treatment of lumbosacral disc herniation. METHOD AND MATERIALS From September 2002 to February 2006 we performed 842 percutaneous laser diode disc decompressions in 708 patients (age 16-84, mean age 42) with relevant symptoms resistant to medical therapy. We used fluoroscopic guidance in 553 patients, CT guidance in 143 and fluoro-CT guidance in 12. The level of disc decompression was L2-L3 in 45 cases, L3-L4 in 96, L4-L5 in 395, L5-S1 in 306. In 48 cases the PL3D was performed after unsuccessful microsurgical approach. The access to the intervertebral disc was performed with a 21G Chiba needle of 100 or 150 mm. The needle was introduced either with an oblique or a paramedian transdural access. In all cases a multidiode laser with a wavelenght of 980 nm was used. The clinical success was evaluated with the MacNab criteria. RESULTS After a mean follow-up of 21 months 618 patients (91%) ...
PURPOSE To evaluate the clinical outcome of Percutaneous Laser Disc Decompression using Multidiod... more PURPOSE To evaluate the clinical outcome of Percutaneous Laser Disc Decompression using Multidiode Laser System under CT guidance in patients with lumbar disc herniation. METHOD AND MATERIALS From December 2004 to March 2005, 51 patients aged 22 to 86 years (mean age 56 years) with lumbar disc herniation were treated with percutaneous laser disc decompression. All procedures were performed in prone decubitus and under local anaesthesia, using only CT guidance. All patients received chemoprophylaxis with cephazolin. A 21G Chiba needle of 100 or 150 mm was positioned into the nucleus pulposus transfixing the hernia. The needle was introduced either with an oblique or a paramedian transdural access. In all cases a multidiode laser with a wavelenght of 980 nm was used. The clinical outcome was evaluated with MacNab criteria and a visual-analogue scale (VAS). RESULTS All procedures were performed in day hospital regimen. Following the MacNab criteria, of 51 patients treated with PL3D und...
PURPOSE Evaluating effectiveness of percutaneous drainage of bacterial and fungal antibiotic resi... more PURPOSE Evaluating effectiveness of percutaneous drainage of bacterial and fungal antibiotic resistant lung abscesses. METHOD AND MATERIALS From December 2000 to December 2008, 23 patients (age 26-81 years) with bacterial and fungal lung abscesses, resistant to antibiotic therapy, were treated with percutaneous CT-guided drainage. Bacterial or fungal abscess diagnosis was confirmed with fine needle aspiration. In 12 patients needle aspiration was effective for drainage, using a 21G and 18G Chiba needle in 7 and 11 patients respectively. In 11 patient 14 Fr catheter positioning was necessary. CT scans were obtained in all patients before, during and after the drainage. Clinical evaluation of abscess resolution was achieved with CT scans. All patients received antibiotic therapy based on the antibiogram obtained after aspiration or empirical basis. RESULTS Complete resolution of the lesions was obtained in all cases. The mean period of hospitalization was 4 days. Drainages were left i...