Radiological evaluation by magnetic resonance of the 'new anatomy' of transsexual patients undergoing male to female sex reassignment surgery.

Magnetic resonance (MR) is the best way to assess the new anatomy of the pelvis after male to female (MtF) sex reassignment surgery. The aim of the study was to evaluate the radiological appearance of the small pelvis after MtF surgery and to compare it with the normal women's anatomy. Fifteen patients who underwent MtF surgery were subjected to pelvic MR at least 6 months after surgery. The anthropometric parameters of the small pelvis were measured and compared with those of ten healthy women (control group). Our personal technique (creation of the mons Veneris under the pubic skin) was performed in all patients. In patients who underwent MtF surgery, the mean neovaginal depth was slightly superior than in women (P=0.009). The length of the inferior pelvic aperture and of the inlet of pelvis was higher in the control group (P<0.005). The inclination between the axis of the neovagina and the inferior pelvis aperture, the thickness of the mons Veneris and the thickness of the rectovaginal septum were comparable between the two study groups. MR consents a detailed assessment of the new pelvic anatomy after MtF surgery. The anthropometric parameters measured in our patients were comparable with those of women.

[Urography: problems and errors in the diagnosis of renal masses]. / Urografia: problemi ed errori nella diagnostica delle masse renali.

New imaging modalities have gained a prominent role in both detection and diagnosis of kidney disorders. However, excretory urography (IVU) remains the screening examination of choice in everyday diagnostic routine, even though its value in characterising renal masses is poor. The search for more sensitive and less invasive diagnostic modalities has brought about some new dilemmas--e.g., which modality should be performed first when the clinical picture is suggestive of renal tumor, the presence of a malignancy with a negative IVU, small renal tumors as occasional findings--, and has enhanced previous problems,--e.g., technique, administration of i.v. contrast media. After defining the above problems, the authors discuss mistakes in the evaluation and interpretation of urograms. The problems are operator-dependent, or else they may be related to examination technique--e.g., inadequate preparation of the patient, poor image quality--, to the method of examination--e.g., inadequate injection of contrast agents (i.e., type, amount, method of injection)--, to kidney function and, finally, to lesion type. As for lesion type, errors can be related to the detection of the lesion itself--e.g., small renal masses (less than 3 cm phi)--and to lesion definition, due to atypical patterns or to difficult differentiation of tumors from normal findings, from anatomical variants or extrarenal structures.

[Surgical ultrasonography of the seminal vesicles in andrologic pathology. Research in progress]. / L'ecografia operativa delle vescicole seminali nella patologia andrologica. Ricerca in "itinere".

The authors describe their experience with percutaneous transperineal puncture (PTP) of the seminal vesicles in andrologic pathologic conditions, using transrectal US guidance. Three cases are reported: 2 anomalies of the genital ducts and one prostatic-vesicular abscess. In the first two cases PTP allowed a diagnosis to be reached on the basis of the analysis of vesicular fluid. Moreover, the examination allowed the selection of the patients to be submitted to surgery for seminal duct anomaly (endoscopic resection of the colliculus seminalis). In cases 1 and 3 PTP allowed the aspiration of the fluid from a cyst in the left ejaculatory duct and from a prostatic-vesicular abscess, respectively. These procedures were facilitated using US guidance. The clinical possibilities and utility of PTP have not yet been completely defined. The authors suggest a diagnostic protocol to be used in the presence of azoocytospermia, where US must be performed only in patients with excretory infertility. The present paper must be considered a work in progress. Further study is required to identify the clinical indications of interventional US of the seminal vesicles in patients with andrologic pathologic conditions.

[Echography vs urography in the study of small-size renal carcinoma]. / Ecografia ed urografia a confronto nello studio dei nefrocarcinomi di piccole dimensioni.

Since 1981 we have studied 34 patients with renal cell carcinomas smaller than 3 cm, diagnosed by US and IVP, to evaluate the diagnostic viability of these 2 procedures. Their respective results were compared to pathologic findings and tumor grading. No correlation was found between the type of sonographic patterns and the pathologic findings. On the contrary the correlation between the acoustic pattern and the grading, performed on small tumors and on a control group of large tumors, showed that most tumors in the former group (70%) had lower grading than those in the latter. We conclude that the introduction of US has changed the approach to the diagnosis of renal tumors, allowing their early recognition and characterisation. It is thus hoped that the clinical course of such tumors will be improved.

[Diagnosis by imaging of secondary neoplastic lesions of the digestive tract]. / La diagnostica per immagini delle lesioni neoplastiche secondarie del canale alimentare.

Secondary neoplasms involving the alimentary tract are not common. This work is aimed at evaluating their characteristic roentgenological features, providing, when possible, the criteria for discriminating secondary from primary lesions. Forty-five patients with secondary neoplasms of the alimentary tract were examined by conventional radiology, ultrasonography and CT. Both CT and US are highly accurate in such cases, since these lesions are displayed directly. However, double-contrast gastrointestinal examination must be performed, because it indirectly demonstrates both intrinsic and extrinsic lesions, thus providing all elements for a correct local staging.

[Diagnostic images of renal angiomyolipoma]. / Diagnostica per immagini dell'angiomiolipoma renale.

The authors report 26 cases of renal angiomyolipomas (AML) detected in a three-years period (1983-85). In all cases echography, in 6 renal arteriography and in 13 CT were performed. The review of the pathway and of literature stress some new aspects in diagnostic problems of AML. The extensive use of diagnostic ultrasound shows an higher rate of tumors than in the pre-echographic period. Most of these lesions are asymptomatic and incidentally detected as small nodules. Ultrasound, combined with CT, can resolve the diagnostic dilemma of benign lesion. An echographic follow-up is sufficient to confirm this evaluation in typical cases. In large or bleeding tumors and when there is a prevalence of connective and/or muscular tissue, a diagnostic and ablative surgery is mandatory.

[Radiologic surveillance of uremic osteodystrophy after parathyroidectomy]. / Sorveglianza radiologica dell'osteodistrofia uremica dopo paratiroidectomia (PTX).

Partial parathyroidectomy (PTX) was carried out 20 times in 15 dialitic patients with chronic renal failure. The operation was suggested by marked radiological abnormalities due to severe secondary hyperparathyroidism, that developed despite aggressive medical and dietetic management. The skeletal x-ray examination showed significant improvement following PTX, that was clearly visible already one month postoperatively at the level of the second and third phalanges of the hands. The improvement of the skeletal osteodystrophic patterns was always associated to a fall of parathyroid hormone and plasma alkaline phosphatase levels. The radiological examination of the hands may represent a usefull and simple method in the follow-up of patients after surgery to assess the efficacy of PTX.

[Functional stenosis of the urethra in girls]. / Le stenosi funzionali dell'uretra nella bambina.

The authors studied 24 girls with distal urethral narrowing at voiding cystourethrography. Their observation seem to confirm that the distal urethral stenosis is generally functional, because often an anatomical obstruction can not be detected with the bougie a boule calibration. The urodynamic and urovideocystographic methods of study allow to differentiate three types of functional urethral stenosis that are not detectable with the radiologic examination alone. The physiopathologic mechanism of the obstruction is the condition for a successful pharmacologic treatment of these small girls.