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Publications (6)4.67 Total impact

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    ABSTRACT: Radiofrequency thermoablation is a locoregional procedure based on the use of electromagnetic waves that induce movement and consequently the production of heat. This is the basis for the coagulative necrosis produced in the tissues. The method, experimented with and developed in the '90s, is today extensively used in the treatment of focal hepatic lesions, both primary and secondary. The factors that condition the procedure are related essentially to the characteristics of the tumours and to the possibility of obtaining a predictable area of necrosis that guarantees the radicality of the treatment. As regards primary neoplasms, it should be stressed that the treatment for hepatocellular carcinoma is implemented only in a small percentage of cases due to both the stage of the cirrhosis and because a wide resection is not justified for small-sized lesions or for recurrences after resection. As far as liver metastases are concerned, particularly those from the colon-rectum, surgery is becoming increasingly indicated. Obviously the conditions are decidedly less demanding than those of surgery in liver parenchyma with cirrhosis. Radiofrequency thermal ablation, even in this condition, has a place as an alternative or in combination with liver resection, particularly during recurrences or in cases of multiple metastases that require extensive extirpative operations. The authors present their experience over the period from February 1999 to December 2002 in 82 patients, 71 with hepatocellular carcinoma and 11 with metastases, treated with radiofrequency thermoablation. Depending upon the site, the number of lesions and the Child-Pugh functional classes in patients with cirrhosis, 117 treatments were carried out: the percutaneous approach was used in 77 cases and the open procedure in 36, while the thermoablation was combined with surgical resection in 4 cases. The results are examined on the basis of perioperative morbidity and mortality and local recurrence, and the time of hospitalisation is compared in the different patient groups. The authors conclude favourably for this procedure, which is associated with an extremely low percentage of complications and with an almost total lack of perioperative mortality, and in some cases may be a valid alternative and in other cases a useful complement to resection treatment.
    Chirurgia italiana 01/2004; 56(1):117-26.
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    ABSTRACT: In recent years digital videofluorography (VFG) with water siphon test (WST) has been proposed just for diagnosing hiatal hernia and/or gastroesophageal reflux. Fifteen patients undergone Laparoscopic Nissen (LN) for complicated GERD associated to hiatal hernia, were referred for VFG and WST in order to evaluate the functional results of surgery. At one-month videofluorographic control thirteen patients had just a minimal prolonged esophageal transit time but only six of these had an early postoperative dysphagia, whereas at six months control the prolonged esophageal transit time was present in three patients two of which complained a very light dysphagia. One patient at one month control had a severe dysphagia, her videofluorography showed a very prolonged esophageal transit time and she had to redo surgery. She had a complete resolution of dyspagia and at the six months videofluorographic control she had a normal esophageal and esophagogastric transit time. One patient, underwent surgery in another hospital, complained a persistent and moderate dysphagia and at one month videofluorografic control was evident a malposition of wrap around the upper part of the stomach and a WST positive for reflux and at six months control clinical finding was worst. He will be evaluated for further endoscopic or surgical treatment. In our experience we believe that VFG is a valid test to identificate the postoperative outcomes giving the surgeons a visual evaluation of their work.
    Annali italiani di chirurgia 01/2004; 75(3):339-42; discussion 342-3. · 0.29 Impact Factor
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    ABSTRACT: Total thyroidectomy is the most popular surgical option in a wide range of indications for the treatment of benign disease of the thyroid. The preference for the procedure derives from a long period of observation and clinical experience dating as far back as the early 'seventies and confirms its safety and efficiency. Nevertheless, many doubts still exist as to the indications in the context of benign thyroid disease, as well as the incidence and seriousness of the complications which, though not frequent, are often invalidating. On the basis of the experience gained over the period from January 1994 to November 2002 in 697 patients undergoing surgery for benign disease of the thyroid, the authors analyse the indications for the various different therapeutic options and evaluate the results of total thyroidectomy in terms of therapeutic efficiency, relapse rates and complications. The latter are analysed on the basis of dividing the patients into 2 groups, one comprising 545 patients treated with total thyroidectomy as first-line treatment and the second consisting of 34 patients treated with total thyroidectomy for relapsing goitre after subtotal thyroidectomy. Comparison of the respective incidences of complications reveals a significant difference between the two groups of patients. Total thyroidectomy after subtotal thyroidectomy presented a significantly higher percentage of complications than initial total thyroidectomy. The authors come out in favour of total thyroidectomy with its low incidence of complications and the radical control of the disease it affords, reserving lobectomy-isthmectomy for selected cases of patients with monolateral disease which does not expose the patient to any risk of relapse.
    Chirurgia italiana 01/2003; 55(2):179-87.
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    ABSTRACT: Swallowing disorders can be secondary to different types of diseases in which, at least initially, patients succeed in establishing voluntary or involuntary compensatory mechanisms that enable them to maintain a sufficient nutritional state. When the compensatory mechanisms become insufficient massive food aspiration into the airways can occur and suffocation may prove to be the main pathology. It has been calculated that in the USA about 8,000-10,000 people die each year due to suffocation. The dynamic radiological examination of swallowing is considered important not only for diagnosis, but also for planning a rehabilitation therapy and type of nutrition for the patient and for verifying the results of the therapy. The aim of this study is to analyse the results of our experience in the use of the digital cineradiography system to evaluate patients with normal and pathological swallowing. We reviewed the digital cineradiography of 220 patients that at no time had undergone surgery and presented no organic pharyngeal or oesophageal disease (excluding hiatus hernia). All the exams followed a standard protocol that included the dynamic evaluation of the larynx, soft palate, pharynx, and gastro-oesophageal junction with a cineradiographic sequence of 12 frames/second with a 512x1024 matrix. There was also an archive of the film in a post-processing console. The patients received single photograms (printed on laserfilm), videotape recordings or CD-ROM of the dynamic exam. 137 (62%) of the patients did not present swallowing alterations although only 7 patients had a negative examination. In 35 cases hiatus hernia was appreciable while in 69 cases the hernia was associated with gastro-oesophageal reflux. In 23 cases aspecific functional disorders of the oesophagus were demonstrated and in 3 cases achalasia. The remaining 83 patients (38%) (37 males and 46 females, average age 57.02 yrs) presented alterations of the oral and/or pharyngeal stages of swallowing: reduction in soft-palate motility (2 cases), unilateral paralysis of the vocal chords (1 case), incontinence of the bolus during the oral stage (8 cases), lingual movement anomalies (4 cases), subepiglottic penetration (62 cases), asymmetric epiglottic tilt, aspiration of the contrast medium in the airway (17 cases), reduction of laryngeal and hyoid bone movement (9 cases), bolus retained in the valleculae and pyriform sinus (13 cases), cricopharyngeal spasm (6 cases), pharyngeal paralysis (1 case); hiatus hernia was also evident in 20 cases and gastro-oesophageal reflux was associated in 13 of them. Overall, 36% of the cases presented an isolated form while 64% of the cases presented a complex dysfunction with several simultaneous alterations. The videofluorographic swallow study is an important step in the diagnostic evaluation of a dysphagic patient not only as regards the analysis of the main alteration and its capacity to confirm the presence or absence of contrast medium aspiration in the airway, but also because it provides important information on rehabilitation and nutritional orientation (oral/no oral), as well as on the results of the therapy. The recent diffusion of the digital X-ray equipment has made possible its use for the study of the organic and functional diseases of the upper alimentary tract. Currently a standard protocol for the study of swallowing with digital fluorography is not available. The technique we applied, already verified in a significant number of dysphagic patients, has allowed us to distinguish patients with normal swallowing from those with disorders of the oral and pharyngeal stage, and thus to identify disturbance and establish an appropriate rehabilitation treatment.
    La radiologia medica 10/2002; 104(3):125-33. · 1.46 Impact Factor
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    ABSTRACT: alla Redazione il 21.12.2001; revisionato il 13.5.2002; restituito corretto il 5.7.2002; accettato per la pubblicazione il 2.8.2002. Indirizzo per la richiesta di estratti: Dott. Scopo. Scopo del lavoro è l'analisi della nostra esperienza sul-l'impiego di un sistema di cineradiografia digitale nella valuta-zione dei pazienti con deglutizione normale e patologica. Materiale e metodi. Abbiamo effettuato la revisione dell'esame cineradiografico digitale di 220 pazienti non sottoposti preceden-temente a nessun intervento chirurgico e non affetti da patologia organica del faringe o dell'esofago (ad eccezione dell'ernia jata-le). Tutti gli esami sono stati eseguiti secondo un protocollo stan-dardizzato comprendente la valutazione dinamica di laringe, pala-to molle, faringe, esofago e giunzione esofago-gastrica con sequen-ze cineradiografiche di 12 immagini/secondo e matrice 512×1024. Sulla consolle di post-processing si è proceduto anche all'archi-viazione dei filmati. Ai pazienti sono stati consegnati singoli foto-grammi (stampati su pellicola laser), videoregistrazione o CD-rom dell'esame dinamico. Risultati. Al termine dell'indagine 137/220 (62%) pazienti non presentavano alterazioni della deglutizione anche se solamente in 7 pazienti l'esame era negativo, mentre in 35 casi metteva in evi-denza la presenza di ernia jatale, in 69 la presenza di ernia asso-ciata a reflusso gastro-esofageo, in 23 turbe funzionali dell'esofa-go ed in 3 casi acalasia. I restanti 83 pazienti (38%) (37 maschi e 46 femmine, età media 57,02 anni) presentavano alterazioni della fase orale e/o faringea della deglutizione, quali: ridotta motilità del palato molle (2 casi), paralisi monolaterale delle corde vocali (1 caso), incontinenza del bolo durante la fase orale (8 casi), ano-malie del movimento linguale (4 casi), penetrazione subepiglotti-ca (62 casi), asimmetria del tilt epiglottico (8 casi), aspirazione di mdc nelle vie aeree (17 casi), ridotta escursione della laringe e/o dell'osso ioide (9 casi), ristagno nelle vallecule e/o seni piriformi (13 casi), spasmo del cricofaringe (6 casi), paralisi faringea (1 caso); era apprezzabile, inoltre, in 20 casi ernia jatale associa-ta in 13 pazienti a reflusso gastro-esofageo. Nel 36% dei casi il disturbo si presentava in forma isolata, mentre nel 64% si trattava di una disfunzione complessa con più alterazioni simultaneamen-te presenti. Discussione e conclusioni. Lo studio dinamico della deglutizio-ne costituisce un momento fondamentale dell'iter diagnostico del paziente disfagico non solo per l'analisi dell'alterazione di base e per la capacità di confermare la presenza o meno di aspirazione di mdc nelle vie aeree, ma anche perché fornisce elementi indispen-sabili per il trattamento riabilitativo, l'orientamento nutrizionale (orale/non orale), nonché per la verifica dei risultati della terapia. Digital cineradiographic swallow study: our expe-rience Purpose. Swallowing disorders can be secondary to different types of diseases in which, at least initially, patients succeed in establishing voluntary or involuntary compensatory mecha-nisms that enable them to maintain a sufficient nutritional state. When the compensatory mechanisms become insufficient mas-sive food aspiration into the airways can occur and suffocation may prove to be the main pathology. It has been calculated that in the USA about 8,000-10,000 people die each year due to suf-focation. The dynamic radiological examination of swallowing is considered important not only for diagnosis, but also for plan-ning a rehabilitation therapy and type of nutrition for the patient and for verifying the results of the therapy. The aim of this study is to analyse the results of our experience in the use of the dig-ital cineradiography system to evaluate patients with normal and pathological swallowing. Materials and methods. We reviewed the digital cineradiogra-phy of 220 patients that at no time had undergone surgery and presented no organic pharyngeal or oesophageal disease (exclud-ing hiatus hernia). All the exams followed a standard protocol that included the dynamic evaluation of the larynx, soft palate, pharynx, and gastro-oesophageal junction with a cineradiograph-ic sequence of 12 frames/second with a 512×1024 matrix. There was also an archive of the film in a post-processing console. The patients received single photograms (printed on laserfilm), vid-eotape recordings or CD-ROM of the dynamic exam. Results. 137 (62%) of the patients did not present swallowing alterations although only 7 patients had a negative examination. In 35 cases hiatus hernia was appreciable while in 69 cases the hernia was associated with gastro-oesophageal reflux. In 23 cas-es aspecific functional disorders of the oesophagus were dem-onstrated and in 3 cases achalasia. The remaining 83 patients (38%) (37 males and 46 females, average age 57.02 yrs) present-ed alterations of the oral and/or pharyngeal stages of swallow-ing: reduction in soft-palate motility (2 cases), unilateral paral-ysis of the vocal chords (1 case), incontinence of the bolus dur-ing the oral stage (8 cases), lingual movement anomalies (4 cas-es), subepiglottic penetration (62 cases), asymmetric epiglottic tilt, aspiration of the contrast medium in the airway (17 cases), reduction of laryngeal and hyoid bone movement (9 cases), bolus retained in the valleculae and pyriform sinus (13 cases), cricoph-aryngeal spasm (6 cases), pharyngeal paralysis (1 case); hiatus hernia was also evident in 20 cases and gastro-oesophageal reflux was associated in 13 of them. Overall, 36% of the cases present-ed an isolated form while 64% of the cases presented a complex dysfunction with several simultaneous alterations. Discussion and conclusions. The videofluorographic swal-low study is an important step in the diagnostic evaluation of a dysphagic patient not only as regards the analysis of the main alteration and its capacity to confirm the presence or absence of contrast medium aspiration in the airway, but also because it provides important information on rehabilitation and nutri-tional orientation (oral/no oral), as well as on the results of the therapy. The recent diffusion of the digital X-ray equipment RADIODIAGNOSTICA RADIOLOGIA GASTROENTEROLOGICA E ADDOMINALE 125 Introduzione La deglutizione è una funzione biologica essenziale la cui alterazione può portare a conseguenze piuttosto gravi quali denutrizione, deidratazione, polmonite da aspirazione o ostru-zione delle vie aeree [1]. I disordini della deglutizione pos-sono essere conseguenti a cause diverse: malattie neuromu-scolari, lesioni strutturali locali della regione oro-faringea, neoplasie del cavo orale, della faringe e/o della laringe, trat-tamenti chirurgici o radioterapici [2, 3]. In alcuni di questi pazienti, specie nelle patologie croniche a lungo decorso, si instaurano dei meccanismi di compenso dell'atto deglutito-rio volontari (modifica della dieta e/o del meccanismo di deglutizione) o involontari; di contro la ridotta sensibilità di cavo orale, faringe e/o laringe unita all'alterazione del mec-canismo della deglutizione, può causare costanti fenomeni di aspirazione di cibo nell'albero tracheo-bronchiale, spes-so non avvertiti dal paziente, ma che possono essere alla base di alterazioni respiratorie (laringospasmo, asma, flo-gosi delle vie aeree). Quando i meccanismi di compenso diventano insufficienti, l'aspirazione massiva di cibo nella via aerea ed il soffocamento possono dimostrare improvvi-samente la patologia di base in tutta la sua gravità. Si cal-cola che negli Usa circa 8000-10.000 persone muoiono per soffocamento ogni anno [4]. L'esame radiologico dinamico è considerato fondamentale sia nella diagnosi di alterazio-ne del meccanismo deglutitorio che nella pianificazione del-la riabilitazione e della nutrizione del paziente e nella veri-fica dei risultati della terapia [1, 2, 5]. Scopo del lavoro è l'analisi della nostra esperienza sul-l'impiego di un sistema di cineradiografia digitale nella valu-tazione dei pazienti con deglutizione normale e patologica. Materiale e metodi Abbiamo effettuato la revisione di 220 cineradiografie eseguite nel periodo compreso tra maggio 2000 e giugno 2001 in pazienti disfagici. Abbiamo preventivamente esclu-so i pazienti sottoposti a interventi chirurgici sul tratto farin-go-esofago-gastrico e quelli in cui, all'esame cineradiogra-fico, si sia dimostrata una patologia organica del faringe o dell'esofago (ad eccezione dell'ernia jatale). I 220 pazienti (99 maschi e 121 femmine) con disturbi della deglutizione presentavano età compresa tra 16 e 81 anni (età media 48,5 anni). Tutti gli esami sono stati eseguiti con apparecchio teleco-mandato con arco a C digitale (Telecomandato Polifunzionale
    La radiologia medica 09/2002; 140(3):125-133. · 1.46 Impact Factor
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    ABSTRACT: urpose. Swallowing disorders can be secondary to different types of diseases in which, at least initially, patients succeed in establishing voluntary or involuntary compensatory mecha- nisms that enable them to maintain a sufficient nutritional state. When the compensatory mechanisms become insufficient mas- sive food aspiration into the airways can occur and suffocation may prove to be the main pathology. It has been calculated that in the USA about 8,000-10,000 people die each year due to suf- focation. The dynamic radiological examination of swallowing is considered important not only for diagnosis, but also for plan- ning a rehabilitation therapy and type of nutrition for the patient and for verifying the results of the therapy. The aim of this study is to analyse the results of our experience in the use of the dig- ital cineradiography system to evaluate patients with normal and pathological swallowing. Materials and methods. We reviewed the digital cineradiogra- phy of 220 patients that at no time had undergone surgery and presented no organic pharyngeal or oesophageal disease (exclud- ing hiatus hernia). All the exams followed a standard protocol that included the dynamic evaluation of the larynx, soft palate, pharynx, and gastro-oesophageal junction with a cineradiograph- ic sequence of 12 frames/second with a 512×1024 matrix. There was also an archive of the film in a post-processing console. The patients received single photograms (printed on laserfilm), vid- eotape recordings or CD-ROM of the dynamic exam. Results. 137 (62%) of the patients did not present swallowing alterations although only 7 patients had a negative examination. In 35 cases hiatus hernia was appreciable while in 69 cases the hernia was associated with gastro-oesophageal reflux. In 23 cas- es aspecific functional disorders of the oesophagus were dem- onstrated and in 3 cases achalasia. The remaining 83 patients (38%) (37 males and 46 females, average age 57.02 yrs) present- ed alterations of the oral and/or pharyngeal stages of swallow- ing: reduction in soft-palate motility (2 cases), unilateral paral- ysis of the vocal chords (1 case), incontinence of the bolus dur- ing the oral stage (8 cases), lingual movement anomalies (4 cas- es), subepiglottic penetration (62 cases), asymmetric epiglottic tilt, aspiration of the contrast medium in the airway (17 cases), reduction of laryngeal and hyoid bone movement (9 cases), bolus retained in the valleculae and pyriform sinus (13 cases), cricoph- aryngeal spasm (6 cases), pharyngeal paralysis (1 case); hiatus hernia was also evident in 20 cases and gastro-oesophageal reflux was associated in 13 of them. Overall, 36% of the cases present- ed an isolated form while 64% of the cases presented a complex dysfunction with several simultaneous alterations. Discussion and conclusions. The videofluorographic swal- low study is an important step in the diagnostic evaluation of a dysphagic patient not only as regards the analysis of the main alteration and its capacity to confirm the presence or absence of contrast medium aspiration in the airway, but also because it provides important information on rehabilitation and nutri- tional orientation (oral/no oral), as well as on the results of the therapy. The recent diffusion of the digital X-ray equipment has made possible its use for the study of the organic and func- tional diseases of the upper alimentary tract. Currently a stan- dard protocol for the study of swallowing with digital fluorog- raphy is not available. The technique we applied, already ver- ified in a significant number of dysphagic patients, has allowed us to distinguish patients with normal swallowing from those with disorders of the oral and pharyngeal stage, and thus to identify disturbance and establish an appropriate rehabilitation treatment. KEY WORDS: Pharynx, functional pathology - Swallowing disorders - Digital cineradiography - Videofluorography swallow study (VFSS)
    La radiologia medica 08/2002; 104:125-133. · 1.46 Impact Factor