[Role of computerized tomography in percutaneous drainage of acute infected necrotic-hemorrhagic pancreatitis]. / Ruolo della Tomografia Computerizzata e del drenaggio percutaneo nelle pancreatiti acute necrotico-emorragiche infette.

In the last few years, Computed Tomography (CT) has emerged as the most sensitive and reliable imaging technique to diagnose acute pancreatitis (AP). Besides assessing the extent of damage to the pancreas and to periglandular tissue. CT can recognize the major early and late complications of the disease promptly and with extreme accuracy. We investigated the diagnostic capabilities of CT in controlling AP development and tried to assess the role of interventional radiology as a therapeutic support after or instead of surgery in treating the necrotic forms of pancreatitis complicated by sepsis. From 1989 to 1995, acute pancreatitis mostly due to biliary tract disease and alcoholism was diagnosed in 228 patients. Necrotic processes were identified in 105 of them since disease onset; septic complications developed in 57 patients. Surgery was performed in 42 patients, but the result was poor in 11 of them (30%) and CT showed the persistence of some infectious pancreatic exudate which had been drained insufficiently. Since sepsis persisted in these patients, the exudate was aspirated percutaneously after positioning appropriate drainage means guided by abdominal CT. Sepsis resolved completely in 10 patients, while one required subsequent surgery. Percutaneous drainage catheters were positioned in 15 patients as the treatment of choice, under CT and US guidance. Sepsis resolved in 7 cases only (45%), while 3 of the extant patients died and 5 needed surgery. The results of our experience demonstrate the effectiveness of percutaneous drainage under CT guidance. However, this technique should be used after and as a support to surgery, the latter remaining the treatment of choice for infectious necrotic AP. Thus, in our experience, the use of percutaneous aspiration instead of surgery proved to be a less effective tool in curing this condition and its use should therefore be limited to high-risk surgical patients.

[The role of portography with computed tomography in the diagnosis of liver metastases from colorectal neoplasms]. / Il ruolo della portografia con Tomografia Computerizzata nella diagnosi di metastasi epatiche da neoplasie del colon-retto.

This study was performed to confirm the high sensitivity of CT during arterial portography (CTAP) versus US and dynamic CT in the diagnosis of liver metastases from colorectal cancer. Ninety patients with 108 colorectal cancers underwent US, dynamic CT and CTAP to investigate the presence of liver metastases. US depicted 39 metastases in 26 patients, dynamic CT 46 metastases in 29 patients and CTAP 54 lesions in 34 patients. CTAP detected 8 metastases missed at dynamic CT; 4 of them were < 1 cm in diameter, 3 ranged 1-2 cm and one metastasis > 2 cm in diameter. After preoperative investigations only 7 patients were considered for hepatic resection. At surgery, palpation and intraoperative US of the liver detected two more metastases in the same patients. Our experience, in agreement with recent studies, confirms CTAP as the most sensitive preoperative method in detecting liver metastases and its superiority to be most apparent in lesions < 1 cm in diameter. Therefore, we consider CTAP an essential imaging technique for planning the correct treatment of liver metastases.

[Percutaneous needle biopsy of the lung. Critical review of 496 cases]. / Agobiopsia percutanea polmonare. Revisione critica di 496 casi.

Between February 1979 and December 1986, 618 lung biopsies were performed on 496 patients (122 with double puncture, using Tru-cut and 19-20 G needles). Overall diagnostic accuracy was 84.5%; the 77 patients examined in the past 18 months only underwent thin needle (19-20 G) biopsies--which were carried out by an experienced radiologist--and more sophisticated cyto-histological techniques were employed. Such a procedure gave better results (sensitivity 94.1%, accuracy 94.8%) than did the use of larger caliber needles in the past years; moreover, no complications occurred in these patients. In conclusion, 19-20 G needles are to be preferred to bigger ones, provided that the operator be experienced and cyto-histology be correctly performed.

Immunoglobulin levels in breast cyst fluid: apparent connection with intracystic transcortin (CBG) binding activity.

Immunoglobulin levels of the major classes of IgG, IgA and IgM have been measured by radial immunodiffusion in 74 samples of breast cyst fluid (BCF) aspirated by women with "Gross Cystic Disease". Appreciable levels of Ig were found in all samples. No significant correlation was observed between intra-cystic Ig levels and the corresponding levels measured on coincidental blood specimens. A significant linear correlation was found between intra-cystic Ig levels and the apparent specific binding activity for cortisol attributable to a transcortin like component (n = 30; p less than 0.05 for IgA, p less than 0.0025 for IgG; p less than 0.05 for IgM).