[Percutaneous treatment of benign biliary stenosis: bilioplasty and stenting]. / Trattamento percutaneo delle stenosi biliari benigne: bilioplastica e stenting.

We reviewed our personal experience in 46 patients with biliary strictures, who underwent percutaneous balloon dilatation between 1983 and 1988. The strictures were iatrogenic in 24% of the cases, anastomotic in 52%, inflammatory in 17%, and associated with sclerosing cholangitis in 7%. The treatment consisted in dilating the bile ducts with balloon catheters of different kinds and sizes ("bilioplasty") and placing an internal drainage catheter for a varying period of time ("stenting"). In 22 patients the catheter was removed after an average time of 7.7 months. The rate of stricture recurrence was 13.5% (average follow-up: 20 months). In the remaining 24 patients the stents are still in situ, waiting for removing. Major complication rate was 6.4% (2 pleural effusions and 1 hepatic artery bleeding). We also report our initial experience with metallic self-expanding stents which appear as a promising tool in the management of recurring strictures.

Endocrine tumors of the pancreas.

We have described the clinical presentation of the commonest syndromes associated with hormone production by functioning pancreatic tumors. The role of the radiologist in tumor localization, staging, and treatment is discussed and the various imaging methods employed are examined individually. The problems of reviewing the world literature on such rare lesions are discussed and a tentative diagnostic algorithm is suggested.

[Therapy of hepatic carcinoma by the intra-arterial injection of lipiodol, antineoplastic agents and gelfoam]. / Terapia degli epatocarcinomi mediante iniezione intra-arteriosa di lipiodol-antiblastici e gelfoam.

Chemoembolization by selective intra-arterial injection of lipiodol--chemotherapeutic agents (mitomycin and/or adriamycin)--followed by terminal embolization with gelfoam was performed on 20 inoperable patients with hepatic tumors: 13 hepatocellular carcinomas (HCC), 6 metastases from colorectal cancer, and one adenoma. A total of 29 embolizations were performed, 17 of them followed by gelfoam embolization. Significant decrease in tumor size or no tumor increase was shown in 8 patients--6 capsulated and well-limited HCC's, and 2 multinodular HCC's. Apart from occasional episodes of post-embolization syndrome (fever, vomit, abdominal pain), no significant complications were observed. Nine patients died at intervals ranging from 2 weeks to 37 months after the first embolization; in 6 patients the cause of death was not related to the advancing of the cancer, but to the complications of the underlying cirrhosis. In cirrhotic patients, damage to the rest of liver parenchyma can be limited by using superselective catheterization. Of the 6 patients with greater than 12 months follow-up, 4 are alive and 2 have died; 2 more patients are still alive 18 months after the first embolization. Finally, lipiodol was useful as radiopaque marker to detect lesion changes during the follow-up.

[Clinical evaluation of biliary endoprostheses. A comparison of endoprostheses made of teflon and percuflex]. / Valutazione clinica delle endoprotesi biliari. Confronto tra endoprotesi in teflon ed in percuflex.

For the decompression of the biliary tree in case of obstructive neoplastic jaundice, 62 biliary endoprostheses were placed in 54 patients as an alternative to internal-external drainage. Teflon prostheses were used in 26 patients--which were placed in the stenotic tract--while in 28 patients soft percuflex prostheses were used, whose lower extremity was placed in the duodenum. The mean survival has been 6-7 months, with peaks ranging from 1 month to 2 years. By comparing the results obtained with the two different kinds of prosthesis we found that soft endoprostheses were associated with a lower incidence of late complications than teflon prostheses: cholangitis occurred in 7.2% of cases (vs teflon: 16%), occlusions in 3.5% (vs teflon: 11.5%), migrations in 7.2% (vs teflon: 7.6%). The incidence of such complications was, however, higher a few months after the application of the prosthesis. This palliative treatment is suggested in patients whose expected survival is not longer than 1-6 months. On the contrary, in case of patients with a better prognosis, an internal-external catheter drainage is preferred, for an easier access to the site of the lesion.