Papers by Francesco Somma
Purpose Assessment of safety and effectiveness of Selective Internal Radiation Therapy (SIRT) usi... more Purpose Assessment of safety and effectiveness of Selective Internal Radiation Therapy (SIRT) using Y-90 microspheres in case of unresectable HCC not responsive to other loco-regional treatments. Methods and Materials Between November 2005 and January 2013, 74 SIRT were performed in 68 patients with unresectable HCC, 19 with portal vein thrombosis (PVT). A Body Surface Area (BSA) index was used in order to determine the dose of drug to administrate, considering size of lesions, liver function and vascular anatomy. Every patient underwent Multislice Computed Tomography (MSCT) scans, angiography with the embolization of the Gastro-duodenal artery and other arteries using micro-coils. Shunting study was performed with injection of TC-99MAA through a 3F microcatheter. Proton-Pomp Inhibitors (PPI) were administered to avoid gastritis and ulcers. Results The average dose administered was 1.7GBq. After-treatment fever and abdominal pain were found in 25 and 19 patients, respectively. No ot...
Journal of biological regulators and homeostatic agents
To validate a rat model of acute arterial mesenteric ischemia correlating MRI patterns with macro... more To validate a rat model of acute arterial mesenteric ischemia correlating MRI patterns with macro and microscopic changes in the small bowel. Thirty Sprague-Dawley rats were assigned to two experimental groups (Group I and Group II) of fifteen rats each. Group I underwent surgical procedure of superior mesenteric artery (SMA) ligation, followed by macroscopic observation. In Group II, a loop was tied loosely around the SMA without occluding the vessel. Three days after surgery, the loop was tied by external tips to completely occlude the artery. 7T microMR (7Tesla microMR) was performed before and 8 hours after SMA occlusion. At predetermined time-points the histopathological examinations were performed in both of groups. Macroscopic monitoring revealed thinning of mesenteric vessels, hypotonic reflex ileus and chromatic change of some loops. 7T microMR sequences evidenced loop dilation with gas-fluid mixed stasis, intraperitoneal free fluid and bowel wall hyperintensity. There were...
PLOS ONE, 2015
To evaluate safety and efficacy of Trans-Arterial Ethanol-Lipiodol Embolization (TAELE) compared ... more To evaluate safety and efficacy of Trans-Arterial Ethanol-Lipiodol Embolization (TAELE) compared with conventional Trans-Arterial Chemo-Embolization (cTACE) in the treatment of small intermediate-HCC (BCLC-Stage B). A random sample of 87 patients (37.93% male; 62.07% female; age range, 36-86 years) with documented small intermediate-HCC and treated with TAELE (mixture 1:1 of Ethanol and Lipiodol) or cTACE (mixture of 50mg-Epirubicin and 5cc-Lipiodol) were retrospectively studied in an institutional review board approved protocol. The two procedures were compared with χ2-test, χ2-test with Yates correction, McNemar's exact test, ANOVA test and log-rank test. TAELE and cTACE therapies were performed in 45 and 42 patients, respectively. Thirty days after the procedure, a Multi-Detector Computed Tomography (MDCT) showed no significant difference in the number of patients with partial and complete response between the two groups (p-value = 0.958), according to mRECIST. Contrary, significant differences were found in tumor-devascularization, lesion-reduction and post-embolization syndrome occurrence (p-value = 0.0004, p-value = 0.0003 and p-value = 0.009, respectively). Similar survival was observed during 36-month follow-up (p-value = 0.884). Compared to cTACE, TAELE showed a better toxicity profile with similar 36-month survival and similar one-month anti-tumor effects, which makes it better tolerated by patients, especially in case of more than one treatment.
La radiologia medica, 2011
Purpose. Acute mesenteric ischaemia (AMI) is a lifethreatening vascular emergency with a high mor... more Purpose. Acute mesenteric ischaemia (AMI) is a lifethreatening vascular emergency with a high mortality rate. Early diagnosis is the key to reducing its mortality rate and improving the quality of life. Although computed tomography (CT) is still the gold standard for acute intestinal disorders, over the last few years, magnetic resonance imaging (MRI) has become a useful alternative tool. An animal model of AMI was developed in order to study the effectiveness of MRI in early detection of this condition and to observe lesion evolution. Methods. Thirty Sprague Dawley rats were randomly divided into two groups (n=15): in the fi rst group, after laparotomy, the animals underwent ligation of the superior mesenteric artery (SMA), followed by macroscopic monitoring and histological evaluation; in the second, ischaemia was induced by squeezing a loop around the SMA 3 days before evaluation with 7-T micro-MRI. Results. Macroscopically, a refl ex spastic ileus followed by refl ex hypotonic ileus and colour changes in some of the loops were detected. MRI evidenced luminal dilatation with air-fl uid levels, free intraperitoneal fl uid and bowelwall oedema. Histological analysis confi rmed ischaemia and earlier damage involving the central portion of the ileum. Conclusions. This model shows the correct sequence of events during arterial AMI and demonstrates that MRI can be recommended for early diagnosis of these lesions.
Journal of medical case reports, 2014
Peutz-Jeghers syndrome is an autosomal dominant disease with incomplete penetrance and variable e... more Peutz-Jeghers syndrome is an autosomal dominant disease with incomplete penetrance and variable expression caused by germline mutation of serine threonine kinase 11/liver kinase B1; it is characterized by hamartomatous polyps in the gastrointestinal tract, mucocutaneous melanin pigmentation, and increased predisposition to neoplasms. In Peutz-Jeghers syndrome, bilateral Sertoli cell testicular tumors cause endocrine manifestations including gynecomastia and feminization. This study aimed to assess the role of breast ultrasound in the evaluation of the effectiveness of an innovative surgical approach. This report presents a pair of European 9-year-old identical male twins with Peutz-Jeghers syndrome, bilateral prepubertal gynecomastia, and testicular multifocal calcifications. Both twins were treated with anastrozole for 2 years. After finishing treatment, both underwent subcutaneous mastectomy performed by the "modified" Webster technique. Breast examination and ultrasound...
Journal of biological regulators and homeostatic agents
Pelvic floor disorders represent a significant cause of morbidity associated with a severe reduct... more Pelvic floor disorders represent a significant cause of morbidity associated with a severe reduction of quality of life. It represents a very common clinical problem that afflicts women three to seven time more often than men. The purpose of this study was to assess the diagnostic tools available to define the imaging strategy in patients with pelvic floor dynamic dysfunctions and to investigate their abilities in the diagnosis of enterocele, elytrocele and edrocele. From January 2008 to May 2011, 614 patients with symptoms related to pelvic floor dynamic dysfunctions were enrolled in our retrospective study. After anamnesis and clinical examination, entero-colpo-defecography (ECD) and supine entero-magnetic resonance (SE-MR) exams were performed in all patients. This study showed that the diagnostic efficacy of ECD is higher than that of SE-MR in the detection of enterocele and edrocele. Furthermore, elytrocele can be visualized only with ECD considering the position of patient dur...
General dentistry
This clinical study reviewed dental surgical extractions that were performed on 532 patients diag... more This clinical study reviewed dental surgical extractions that were performed on 532 patients diagnosed at risk of thromboembolism without interrupting their anticoagulant therapy. The results confirmed that anticoagulant therapy can be modified successfully and does not need to be interrupted, which can carry significant risks.
Journal of endodontics, 2007
During the past few decades endodontic treatment has benefited from the development of new techni... more During the past few decades endodontic treatment has benefited from the development of new techniques and equipment, which have improved outcome and predictability. Important attributes such as the operating microscope and ultrasonics (US) have found indispensable applications in a number of dental procedures in periodontology, to a much lesser extent in restorative dentistry, while being very prominently used in endodontics. US in endodontics has enhanced the quality of treatment and represents an important adjunct in the treatment of difficult cases. Since its introduction, US has become increasingly more useful in applications such as gaining access to canal openings, cleaning and shaping, obturation of root canals, removal of intracanal materials and obstructions, and endodontic surgery. This comprehensive review of the literature aims at presenting the numerous uses of US in clinical endodontics and emphasizes the broad applications in a modern-day endodontic practice.
Seminars in Ultrasound, CT and MRI, 2015
Maxillofacial region is an anatomically complex area, representing a crossroads of different syst... more Maxillofacial region is an anatomically complex area, representing a crossroads of different systems and apparatus. It is defined as the anatomical region lying on the facial skeleton from the inferior outline of maxilla up to an ideal plane passing through the skull base and the inion point, posteriorly. In this area, the digestive and respiratory systems connect to themselves and open in the mouth and sino-nasal cavities. Even the orbits with the ocular globes and their surrounding tissues lie in the same area. Despite the little exposed surface, the chance of penetrating injuries to this site is at least similar to other regions of the body due to the "pivotal role" of the face in human relations. Moreover, the external openings of respiratory and digestive systems and the orbital cavities represent an easy way in for foreign bodies (FBs). Based on the access paths, it is possible to distinguish ingested, inhaled, penetrating, and iatrogenic (owing to surgery) FBs. FB may stop in oral and ocular cavities, or proceed deeply, reaching the surrounding soft tissues, the facial bones, or other cavities such as sino-nasal region, mouth, orbits, and further spaces of the head and neck region, like infratemporal fossa, parapharyngeal space, and sphenopalatine fossa. Furthermore, FBs accidentally introduced and lost in visceral cavities (mouth, ear, and nose), particularly in pediatric subjects, may be quickly removed during direct inspection. Semin Ultrasound CT MRI 36:2-7 C 2014 Published by Elsevier Inc.
PURPOSE Our purpose is to assess and compare the survival of patients with portal vein thrombosis... more PURPOSE Our purpose is to assess and compare the survival of patients with portal vein thrombosis (PVT) and patients without PVT after a TARE using Y-90 microspheres of unresectable HCC, not responsive to other loco-regional treatments. METHOD AND MATERIALS Between November 2005 and February 2013, 81 TARE were performed in 74 patients (43% male; 57% female; range of age 28-84years) with unresectable HCC (size of lesions 1.1 to 5.5cm) and bilirubine values up to 2.6 mg/dl, 21 with PVT. Every patient was studied with Multislice Computed Tomography (MSCT) scans and angiography while just 12 of them underwent the embolization of the Gastro-duodenal artery, using micro-coils. In these cases, a previous study was performed with the injection of TC-99MAA through a 3F microcatheter. Proton-Pump Inhibitors (PPI) were administered to prevent gastritis and ulcers. RESULTS The average dose administered was 1.7GBq. After the treatment, fever and abdominal pain were found in 29 and 19 patients, r...
Japanese Journal of Radiology, 2014
Purpose Estimation of skeletal muscle metastases (SMMs) at the time of diagnosis and/or initial s... more Purpose Estimation of skeletal muscle metastases (SMMs) at the time of diagnosis and/or initial staging of lung cancer. Materials and methods Retrospective evaluation of clin-ical charts and imaging data suggestive of SMMs of patients with histology-proved lung cancer over a 5-year period. Results SMMs were identified in 46 out of 1,754 patients. Single and multiple (62.9 % of cases) SMMs were detected by total body multi-detector computed tomography (MDCT). They were associated with poorly differentiated (43 %) and advanced adenocarcinomas (52 %) without clinically relevant symptoms and/or signs. Psoas and but-tock muscles were most frequently involved (33.3 %). MDCT findings consisted of well-defined homogeneously hyperdense oval masses (31 %), lesions with ringlike enhancement and central hypoattenuation (68 %), or large abscess-like necrotic lesions (24 %). Sonography revealed well-defined hypoechoic masses (41.6 %), ill-defined hypoechoic lesions (33.3 %), or anechoic areas with a necrotic centre (25 %). Positron emission tomography revealed that all SMMs were metabolically active. Conclusions SMMs are uncommon but not negligible in lung cancer, with an estimated prevalence of 2.62 % in our series. Although histology remains the recommended method, use of high-performance imaging techniques and increased clinical suspicion may improve their early detection. Efforts addressing their effect on the natural history of lung cancer are needed.
Seminars in Ultrasound, CT and MRI, 2015
Ingestion, inhalation, and insertion of foreign bodies (FBs) are very common clinical occurrences... more Ingestion, inhalation, and insertion of foreign bodies (FBs) are very common clinical occurrences. In any case, early diagnosis and prompt management are mandatory to avoid severe and life-threatening complications. Radiologists have an important role in revealing the presence, dimension, nature, and relationship with anatomical structures of a FB; selecting the most appropriate imaging modality; and enabling the best therapeutic choice. This review article focuses on the most frequent FBs ingested, inhaled, and inserted and presents the different tests and investigations to provide a correct radiological approach. Semin Ultrasound CT MRI 36:48-56 C 2014 Elsevier Inc. All rights reserved.
The aim of the present study was to investigate whether cyclic fatigue resistance is increased fo... more The aim of the present study was to investigate whether cyclic fatigue resistance is increased for nickeltitanium instruments manufactured by using new processes. This was evaluated by comparing instruments produced by using the twisted method (TF; SybronEndo, Orange, CA) and those using the M-wire alloy (GTX; Dentsply Tulsa-Dental Specialties, Tulsa, OK) with instruments produced by a traditional NiTi grinding process (K3, SybronEndo). Tests were performed with a specific cyclic fatigue device that evaluated cycles to failure of rotary instruments inside curved artificial canals. Results indicated that size 06-25 TF instruments showed a significant increase (p Ͻ 0.05) in the mean number of cycles to failure when compared with size 06-25 K3 files. Size 06-20 K3 instruments showed no significant increase (p Ͼ 0.05) in the mean number of cycles to failure when compared with size 06-20 GT series X instruments. The new manufacturing process produced nickel-titanium rotary files (TF) significantly more resistant to fatigue than instruments produced with the traditional NiTi grinding process. Instruments produced with M-wire (GTX) were not found to be more resistant to fatigue than instruments produced with the traditional NiTi grinding process. (J Endod 2008;34: 1003-1005
Journal of Endodontics, 2008
The aim of this study was to compare the effectiveness of the Mtwo R (Sweden & Martina, Padova, I... more The aim of this study was to compare the effectiveness of the Mtwo R (Sweden & Martina, Padova, Italy), ProTaper retreatment files (Dentsply-Maillefer, Ballaigues, Switzerland), and a Hedström manual technique in the removal of three different filling materials (gutta-percha, Resilon [Resilon Research LLC, Madison, CT], and EndoRez [Ultradent Products Inc, South Jordan, UT]) during retreatment. Ninety single-rooted straight premolars were instrumented and randomly divided into 9 groups of 10 teeth each (n ϭ 10) with regards to filling material and instrument used. For all roots, the following data were recorded: procedural errors, time of retreatment, apically extruded material, canal wall cleanliness through optical stereomicroscopy (OSM), and scanning electron microscopy (SEM). A linear regression analysis and three logistic regression analyses were performed to assess the level of significance set at p ϭ 0.05. The results indicated that the overall regression models were statistically significant. The Mtwo R, ProTaper retreatment files, and Resilon filling material had a positive impact in reducing the time for retreatment. Both ProTaper retreatment files and Mtwo R showed a greater extrusion of debris. For both OSM and SEM logistic regression models, the root canal apical third had the greatest impact on the score values. EndoRez filling material resulted in cleaner root canal walls using OSM analysis, whereas Resilon filling material and both enginedriven NiTi rotary techniques resulted in less clean root canal walls according to SEM analysis. In conclusion, all instruments left remnants of filling material and debris on the root canal walls irrespective of the root filling material used. Both the engine-driven NiTi rotary systems proved to be safe and fast devices for the removal of endodontic filling material. (J Endod 2008;34:466 -469)
La radiologia medica, 2014
for directing the patient towards the most appropriate treatment, avoiding surgery when not neces... more for directing the patient towards the most appropriate treatment, avoiding surgery when not necessary.
Journal of Endodontics, 2008
Tooth discoloration varies in etiology, appearance, localization, severity, and adhesion to tooth... more Tooth discoloration varies in etiology, appearance, localization, severity, and adhesion to tooth structure. It can be defined as being extrinsic or intrinsic on the basis of localization and etiology. In this review of the literature, various causes of tooth discoloration, different bleaching materials, and their applications to endodontically treated teeth have been described. In the walking bleach technique the root filling should be completed first, and a cervical seal must be established. The bleaching agent should be changed every 3-7 days. The thermocatalytic technique involves placement of a bleaching agent in the pulp chamber followed by heat application. At the end of each visit the bleaching agent is left in the tooth so that it can function as a walking bleach until the next visit. External bleaching of endodontically treated teeth with an in-office technique requires a high concentration gel. It might be a supplement to the walking bleach technique, if the results are not satisfactory after 3-4 visits. These treatments require a bonded temporary filling or a bonded resin composite to seal the access cavity. There is a deficiency of evidence-based science in the literature that addresses the prognosis of bleached nonvital teeth. Therefore, it is important to always be aware of the possible complications and risks that are associated with the different bleaching techniques. (J Endod 2008; 34:394 -407)
The Egyptian Journal of Radiology and Nuclear Medicine, 2015
Synovial sarcoma has been defined by the World Health Organization (WHO) in 2002 as a type of mes... more Synovial sarcoma has been defined by the World Health Organization (WHO) in 2002 as a type of mesenchymal tissue cell tumor that exhibits epithelial differentiation and represents the third most common soft-tissue sarcoma in adults, accounting for approximately 10% of soft-tissue sarcomas. To date, only few reports have focused on mediastinal synovial sarcoma imaging findings. Herein, we report a case of a 13 cm primary mediastinal giant synovial sarcoma, diagnosed in a 56-year-old patient admitted in our Department of Radiology with a six-month history of dyspnea and back pain.
World Journal of Gastroenterology, 2012
To define the evolution of ischemic lesions with 7T magnetic resonance imaging (7T-MRI) in an ani... more To define the evolution of ischemic lesions with 7T magnetic resonance imaging (7T-MRI) in an animal model of acute colonic ischemia.
Seminars in Ultrasound, CT and MRI, 2012
Radiologists receive little formal training regarding the structure of the radiology report and i... more Radiologists receive little formal training regarding the structure of the radiology report and its importance as a medicolegal document; failure to communicate, in fact, represents one of the main problems facing the modern radiologists' activity. Duty to the patient does not end anymore with the written report; the paradox is that we are so advanced in imaging technology, but not in communicating imaging findings. Communication must be timely, appropriate, and fully documented. There is an increasing trend to communicate results directly to the patients; radiologists have the greatest problem when communicating unexpected findings. To improve patient care and reduce the risk of being sued, radiologists should follow shared report guidelines and be more familiar with their professional responsibilities. Semin Ultrasound A lthough imaging technologies have undergone dramatic evolution over the past century, radiology reporting has remained largely static, in both content and structure. Existing free-text reports have been often criticized for a number of inherent deficiencies, including inconsistencies in content, structure, organization, and nomenclature. 1 A radiology report should be accurate and expressed with appropriate confidence with respect to current best practice and knowledge; it has to measure up the central role of the radiologist in the patient's care and management. By providing high-quality service, in fact, the radiologist will continue to be quoted, by other physicians, as a congenial professional colleague who offers valuable advice. Quality has become a critical issue for radiologists. Measuring and improving quality is essential not only to ensure optimum effectiveness of care and comply with increasing regulatory requirements, but also to combat current trends leading to commoditization of radiology services. Unfortunately, radiologists receive little formal training regarding the structure of the radiology report and its importance as a medicolegal document. 3 Good reporting has to include the description of the images, providing the classic radiologic findings, the diagnostic conclusion, and, eventually, the suggestion of further diagnostic imaging tests. Moreover, to reduce medicolegal consequences, a good radiology reading should be complete and correct, with appropriate construction; provide speedy diagnostic information, particularly in the emergency setting; reveal the ability to carry out and optimize the examination, including the imaging technique and the used contrast agent (justification); disclose all the information regarding the administered radiation dose, confirming that the residual risk has been as low as reasonable (optimization); and be clinically focused and attempt to answer the specific question for which the imaging study was performed.
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Papers by Francesco Somma