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1.
Eur Rev Med Pharmacol Sci ; 23(5): 2244-2252, 2019 Mar.
Article in English | MEDLINE | ID: mdl-30915772

ABSTRACT

OBJECTIVE: This is a retrospective study on Pharmacomechanical Catheter-Directed Thrombolysis (PCDT) in the treatment of acute iliofemoral Deep Vein Thrombosis (DVT). PATIENTS AND METHODS: From March 2013 to November 2016, 22 patients (26 limbs), median age 46.7 years with acute (<21 days) extensive iliofemoral DVT underwent Percutaneous Mechanical Thrombectomy (PMT) with Aspirex (Straub Medical, Wangs, Switzerland), followed by Catheter-Directed Thrombolysis (CDT). Subsequent endovascular stenting was performed for underlying obstruction. The follow-ups were conducted up to 1 year, in two Centers by experienced operators. Post-Thrombotic Syndrome (PTS) was evaluated by assessing the Villalta Scale (VS) and measuring orthostatic venous pressure. RESULTS: Post-operative iliofemoral vein patency was restored in almost all cases (95.5%). Standard urokinase dose was 80.000 IU per hour; mean infusion time was 32.5 hours. Stenting was performed in 15 cases (68%). Median follow-up was 19.9 months (6-48 months); 21/22 patients completed the 12 months follow-up. At 30 days follow-up symptoms disappeared in 21/22 cases (95.5%), with one case (4.5%) of DVT recurrence. At 1-year follow-up there were 3 cases (14.2%) of mild PTS; 18 patients (85.8%) were free from PTS. At 1-year follow-up venous pressure measurement showed normal values in 11 cases (52.4%), mild hypertension in 7 patients (33.3%), moderate hypertension (80-100 mmHg) in 2 cases (9.5%) and severe hypertension (110 mmHg) in one case (4.8%). Neither major nor minor complications were observed. CONCLUSIONS: PMT with Aspirex combined with CDT with urokinase seems to be a safe and effective treatment for acute iliofemoral DVT and it shows promising results in reducing the risk of PTS. Thus, we suggest a controlled trial with this treatment strategy.


Subject(s)
Fibrinolytic Agents/administration & dosage , Postthrombotic Syndrome/epidemiology , Thrombectomy/instrumentation , Urokinase-Type Plasminogen Activator/administration & dosage , Venous Thrombosis/therapy , Adult , Aged , Aged, 80 and over , Female , Femoral Vein/diagnostic imaging , Femoral Vein/surgery , Fibrinolytic Agents/pharmacology , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Urokinase-Type Plasminogen Activator/pharmacology , Vascular Patency/drug effects , Venous Thrombosis/diagnostic imaging
2.
Eur Rev Med Pharmacol Sci ; 19(2): 293-5, 2015.
Article in English | MEDLINE | ID: mdl-25683945

ABSTRACT

OBJECTIVE: Venous thromboembolism (VTE) is a severe preventable disease; HIV-infection represents a prothrombotic condition, because of specific factors due to the virus itself, the host response and the antiretroviral therapy. Our aim is to raise awareness of thromboembolic risk when dealing with HIV-positive patients presenting to the Emergency Department for treatment of injuries, even though small. CASE REPORT: We present a case of a 33-year-old woman suffering from HIV-infection who presented to the Emergency Department with two small stab wounds. Laboratory tests and radiologic examinations were normal. About 8 hours after admission the patient developed a syncopal attack: a CT scan performed after hemodynamic stabilization revealed a massive pulmonary embolism (PE); the patient was then transferred to the Intensive Care Unit and treated with systemic thrombolysis. CONCLUSIONS: This case confirms that HIV-positive patients carry a higher risk for VTE and PE compared to general population, similarly to patients suffering from cancer: emergency physicians must be aware even in case of minor wounds.


Subject(s)
HIV Infections/blood , Pulmonary Embolism/virology , Wounds, Stab/blood , Wounds, Stab/virology , Adult , Emergency Service, Hospital , Female , HIV Infections/pathology , Humans , Intensive Care Units , Pulmonary Embolism/blood , Pulmonary Embolism/etiology , Risk Factors , Tomography, X-Ray Computed , Wounds, Stab/complications
3.
Eur Radiol ; 23(1): 182-9, 2013 Jan.
Article in English | MEDLINE | ID: mdl-22836160

ABSTRACT

OBJECTIVES: Metastatic breast cancer is a heterogeneous disease, commonly affecting the liver. We report our experience with (90)Y radioembolisation (RE) and its effects on the survival of patients with treatment-refractory breast cancer liver metastases. METHODS: A total of 77 female patients affected by breast cancer were accepted into our department for RE. Inclusion criteria were inoperable and chemotherapy-refractory hepatic metastases, acceptable performance status, sufficient residual liver, no significant hepato-pulmonary shunts. Patients were divided in two groups: group 1 (29 patients) included those with Eastern Cooperative Oncology Group (ECOG) score 0, liver involvement (0-25 %) and no extrahepatic disease (EHD); group 2 (23 patient) included patients with ECOG score 1-2, liver involvement (26-50 %) and evidence of EHD. RESULTS: A total of 25 patients were considered ineligible. The median age of the remaining 52 patients was 57.5 years. The median overall survival was 11.5 months and better in those whose performance status and liver function were preserved (14.3 versus 8.2 months). According to Response Evaluation Criteria in Solid Tumor (RECIST), partial response (PR) was achieved in 29 patients (56 %), stable disease (SD) was achieved in a further 18 patients (35 %) and 5 patients showed progressive disease (PD) (10 %). DISCUSSION: (90)Y RE is effective in the treatment of liver metastases from breast cancer. We demonstrated a relevant survival and encouragingly high response rate in patients with treatment-refractory disease.


Subject(s)
Breast Neoplasms/pathology , Chemoembolization, Therapeutic/methods , Liver Neoplasms/radiotherapy , Liver Neoplasms/secondary , Yttrium Radioisotopes/therapeutic use , Disease Progression , Female , Humans , Liver Function Tests , Microspheres , Middle Aged , Survival Rate , Treatment Outcome
4.
Radiol Med ; 112(3): 354-65, 2007 Apr.
Article in English, Italian | MEDLINE | ID: mdl-17440697

ABSTRACT

PURPOSE: The purpose of this study was to evaluate the adjunctive diagnostic value of breast ultrasonography (US) in the study of benign ductal breast disease. MATERIALS AND METHODS: Fifty-two patients underwent US examinations for bloody nipple discharge, palpable retroareolar masses, retroareolar opacities or ductal pattern on mammography. US enabled visualisation of mammary-duct ectasia (simple or pseudocystic, retroareolar and/or peripheral) and focal masses (endoluminal or periductal, with ill-defined or regular margins). All patients with nipple discharge underwent cytological evaluation. After the US examination, all focal masses with ill-defined margins underwent fine-needle aspiration biopsy (FNAB), if necessary. The benign alterations were followed up. RESULTS: In 38/52 cases, US diagnosed mammary-duct ectasia and in 30/52 cases, the presence of focal masses (mean size 7 mm). In the nine women who underwent biopsy, histopathological evaluation diagnosed five solitary papillomas, one solitary papilloma with a focal area of ductal carcinoma in situ (DCIS), two multiple papillomas of the nipple and one papillomatosis. CONCLUSIONS: High-frequency US plays an important role in the detection of benign ductal disease both for the diagnosis and classification of focal masses and mammary-duct ectasia. US can be used as a complementary imaging method to galactography or as a valuable alternative when galactography is not available.


Subject(s)
Breast Diseases/diagnostic imaging , Breast Neoplasms/diagnostic imaging , Papilloma/diagnostic imaging , Ultrasonography, Mammary , Adult , Aged , Biopsy, Needle , Breast/pathology , Breast Diseases/pathology , Breast Neoplasms/pathology , Carcinoma in Situ/pathology , Carcinoma, Ductal, Breast/pathology , Diagnosis, Differential , Exudates and Transudates/cytology , Female , Follow-Up Studies , Humans , Mammography , Middle Aged , Nipples/metabolism , Papilloma/pathology , Predictive Value of Tests , Sensitivity and Specificity , Time Factors
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