Ultrasound signs of pulmonary fibrosis in systemic sclerosis as timely indicators for chest computed tomography.

OBJECTIVES: Systemic sclerosis (SSc) patients in the early stages of pulmonary fibrosis (PF) often have few or no symptoms, normal to borderline pulmonary function tests, and negative chest X-ray (CXR); high-resolution computed tomography (HRCT) is the only reliable means of detecting the early signs of PF. However, thoracic ultrasound (TUS) enables detection of pleural thickening, pleural/subpleural nodules, and other subpleural lung abnormalities across 70% of the subpleural surface. We reassessed concordance between TUS abnormalities and HRCT findings in SSc patients, to see whether TUS pleural line thickness (normally <3.0 mm) could be used to earmark those with asymptomatic PF for timely HRCT assessment. METHOD: In total, 175 SSc patients (nine males, 166 females), aged 46.46±15.33 years, were given CXR, TUS, HRCT, echocardiography, and pulmonary function tests. RESULTS: In the 26 patients without HRCT signs of PF, pleural line thickness was ≤3.0 mm. In diffuse SSc, 97/137 patients showed pleural line thickening (between 3.0 and 5 mm) and subpleural nodules in 32/97; and 35/137 showed major pleural line thickening (≥5.0 mm) with nodules, with good concordance with HRCT patterns indicating lung fibrosis severity. HRCT was normal in 5/137, with pleural line thickness≤3.0 mm. CONCLUSIONS: TUS imaging of pleural/subpleural structures can detect ultrasonographic signs of initial PF prior to the onset of respiratory symptoms and function test abnormalities and, together with current criteria, could thereby enable exclusion of PF in SSc patients. Indicating some patients for selective referral to HRCT can thereby delay unwarranted procedures, provided that pulmonary function and TUS images are stable.

Imaging of underground cavities with cosmic-ray muons from observations at Mt. Echia (Naples).

Muography is an imaging technique based on the measurement of absorption profiles for muons as they pass through rocks and earth. Muons are produced in the interactions of high-energy cosmic rays in the Earth's atmosphere. The technique is conceptually similar to usual X-ray radiography, but with extended capabilities of investigating over much larger thicknesses of matter thanks to the penetrating power of high-energy muons. Over the centuries a complex system of cavities has been excavated in the yellow tuff of Mt. Echia, the site of the earliest settlement of the city of Naples in the 8th century BC. A new generation muon detector designed by us, was installed under a total rock overburden of about 40 metres. A 26 days pilot run provided about 14 millions of muon events. A comparison of the measured and expected muon fluxes improved the knowledge of the average rock density. The observation of known cavities proved the validity of the muographic technique. Hints on the existence of a so far unknown cavity was obtained. The success of the investigation reported here demonstrates the substantial progress of muography in underground imaging and is likely to open new avenues for its widespread utilisation.

A surface acoustic wave bio-electronic nose for detection of volatile odorant molecules.

In this work, a "bio-electronic nose" for vapour phase detection of odorant molecules based on surface acoustic wave (SAW) resonators is presented. The biosensor system is composed of an array of five SAW resonators coated with three types of odorant-binding proteins (OBPs): the wild-type OBP from bovine (wtbOBP), a double-mutant of the OBP from bovine (dmbOBP), and the wild-type OBP from pig (wtpOBP). High resolution deposition of OBPs onto the active area of SAW resonators was implemented through laser-induced forward transfer (LIFT). The resonant frequency shifts of the SAW resonators after the deposition of the biomolecules confirmed the immobilisation of the proteins onto the Al/Au inter-digital transducers (IDTs). In addition, a low increase of insertion losses with a limited degradation of Q-factors is reported. The "bio-electronic nose" fabricated by LIFT is tested in nitrogen upon exposure to separated concentrations of R-(-)-1-octen-3-ol (octenol) and R-(-)-carvone (carvone) vapours. The "bio-electronic nose" showed low detection limits for the tested compounds (i.e. 0.48 ppm for the detection of octenol, and 0.74 ppm for the detection of carvone). In addition, the bio-sensing system was able to discriminate the octenol molecules from the carvone molecules, making it pertinent for the assessment of food contamination by moulds, or for the evaluation of indoor air quality in buildings.

A study on the distribution of Bothriocephalus andresi (Cestoda, Pseudophyllidea) in Citharus linguatula.

The distribution of Bothriocephalus andresi (Porta, 1911) in a population of Citharus linguatula (L.) caught off the Tuscan coasts was studied for one year. The negative binomial model proved useful for analysing the distribution of the parasite (B. andresi) in the host population. The ability of the parasite to adjust not only to its own environment but also to that of its host was clear, as it may be evinced from the greater amount of eggs and, hence, of larvae noticed in the period when there was abundance of plankton (high number of intermediate hosts). The balance achieved between host and parasite populations was also evident, and the modulation of the intensity of the infestation was such that it may be imputed to a greater immune response in the host.

[Localization of DNA sequences tightly associated with synaptonemal complex in compositional fractions of golden hamster]. / Lokalizatsiia posledovatel'nostei DNK, prochno assotsirovannykh s sinaptonemym kompleksom, v kompozitsionnykh fraktsiiakh zolotistogo khomiachka.

The synaptonemal complex isolated from the spermatocyte nuclei by exhaustive hydrolysis of the latter by DNase II contains tightly associated DNA sequences (SCAR DNA). Here we studied the compositional properties of a cloned family of SCAR DNA of golden hamster, namely we performed the localization of 27 SCAR DNA clones on compositionally fractionated genomic DNA from golden hamster. We observed that sequences of the SCAR DNA family are mainly localized in the GC-poor isochore families L1 and L2, that showed 63% hybridization signals. This means that 37% of signals is referred to the GC-rich isochores, indicating the presence of SCAR DNA overall the genome, even if each isochore family presents differences in density and sequence type. Moreover, the SCAR DNA sequences containing regions of homology with LINE/SINE repeats were observed in all the isochore families. The compositional localization of SCAR DNA is in agreement with the hypothesis that SC and SCAR DNA participate in the chromatin organization during the meiosis prophase I, which should result in the attachment of chromatin loops to lateral elements of SC along the whole length of the latter.

[Early diastolic sound in a patient with hepatocarcinoma]. / Un tono aggiunto protodiastolico in un paziente affetto da epatocarcinoma.

On physical examination an early diastolic sound is usually associated with mitral stenosis, prosthetic mitral valve replacement and chronic constrictive pericarditis. In case of an atrial myxoma, an early diastolic sound can be usually heard due to movement of the tumor towards the tricuspid valve (tumor plop). The following case report shows an example in which an early diastolic sound was heard in a patient presenting with a hepatocellular carcinoma. This sound was due to the presence of a thrombus that originated from the inferior vena cava and invaded the right atrium up to the tricuspid valve. It was thus similar to an atrial myxoma and produced a tumor plop.

[Renovascular hypertension: possibilities of echo-color Doppler]. / L'ipertensione reno-vascolare: le possibilità dell'eco-color Doppler.

The evaluation of blood flow at the level of renal arteries by echo-Doppler may be useful in detecting a stenosis in patients affected by arterial hypertension. We studied 33 subjects with arterial hypertension using the most suitable scansions to visualize renal arteries. The measured parameters (R.I. and Vmax) resulted to be higher than normal range in 7 and 1 patients respectively. Then these patients underwent renal scintigraphy and arteriography; in 3 of them the presence of a stenosis of a renal artery was confirmed. Therefore the echo-Doppler study of renal arteries, even if has some shortcomings due to technic troubles, revealed to be a useful tool in the screening of hypertensive patients to support the other tools already used to this aim.

[Ureteral jet during medical treatment of benign prostatic hypertrophy]. / Il "jet" ureterale in corso di trattamento medico dell'ipertrofia prostatica benigna.

By Color-Doppler ultrasound it's possible to visualize urine flow from ureter into the bladder. Aim of the study was to image these ureteral jets in patients with benign prostatic hyperplasia (BPH) before and after therapy. Seven patients were studied, whose age ranged from 52 to 69 years; they were not affected by methabolic, hepatic, renal diseases and by prostate inflammation. A duplex scanner (Toshiba SSA 270 A) with a convex probe of 3.5 MHz was used. A transabdominal ultrasound study was performed, measuring prostatic volume and imaging ureteral jet before and along a treatment (at four months intervals) with Finasteride 5 mg/die (Finastid, Neopharmed) and at the end of treatment. We found that the mean velocity of jets in patient affected by was higher than in healthy subjects (80 cm/sec vs 60 cm/sec) bur during treatment it decreased along with symptom improvements and decreasing volume at US. We concluded that analysis of ureteral jets with Color-Doppler P.W. may add useful informations to real-time us in the study of patients affected by BPH undergoing treatment with Finasteride.

[Pulsed-wave color Doppler echography of the intrarenal vessels in patients with insulin-dependent diabetes mellitus and incipient nephropathy]. / L'ecocolor Doppler P.W. dei vasi intrarenali nei pazienti con diabete mellito insulino dipendente (IDDM) e iniziale nefropatia.

Diabetic nephropathy affects a subset of about 40% patients with Insulin-Dependent Diabetes Mellitus (IDDM); it also develops in a less defined percentage (30-50%) of patients with non Insulin-Dependent Diabetes Mellitus (NIDDM), after a period of 15-20 years. It is usually divided in 5 stages: the first 3 are characterized by renal hypertrophy and increased glomerular filtration surface area (I stage) followed by glomerular histological lesions (II stage) and early nephropathy with microalbuminuria (III stage). At these stages nephropathy is still reversible by medical treatment (ACE inhibitors) and good metabolic control. Aim of this study was to assess the usefulness of duplex sonography with Doppler wave form analysis in the evaluation of early diabetic nephropathy, in order to detected patients at risk for irreversible renal disease. Fifteen patients (10 males and 5 females) aged 28-46 years, affected by IDDM were studied; 15 healthy subjects (7 males and 8 females) aged 20-45 years composed the control group. All of them underwent duplex Doppler sonography of kidney; a scanner with a 3.5 MHz transducer (Toshiba 270 SSA) was used. All patients had renal function tests within normal range. Pulsatily Index (P.I.) and Resistive Index (R.I. of Doppler waveform were obtained at the interlobar arteries; the average value of 3 bilateral measurements was taken. Doppler sonography was done by the same authors without knowledge of the patient group (case or control). Both indexes (P.I. and R.I.) resulted to have higher values in patients with IDDM compared to controls: P.I. = 1.46 +/- 0.30 vs. 1.07 +/- 0.06, p < 0.05; R.I. = 0.77 +/- 0.09 vs 0.60 +/- 0.03, p < 0.05. Even if our data have to be confirmed by further studies, they suggest that duplex Doppler sonography may be a useful complementary test in the evaluation of diabetic nephropathy, even in the early stages.

[Echo-Doppler evaluation of the renal arterial flow in hepatic cirrhosis]. / Valutazione mediante eco-Doppler del flusso arteriolare renale in corso di cirrosi epatica.

In liver cirrhosis the sodium retention depends on a decreased renal perfusion by arteriolar vasoconstriction. To evaluate the usefulness of echo-Doppler in detecting such hemodynamic impairment, we studied 16 cirrhotic patients and 16 healthy subjects as control group. We measured Pulsatility Index (P.I.) and Resistivity Index (R.I.). Both parameters resulted to be statistically higher in cirrhotic patients than in controls; moreover they resulted to be higher in cirrhotics with ascites than in those without. Therefore echo-Doppler can detect intraparenchymal renal vasoconstriction in cirrhosis, this impaired perfusion is already evident before ascites formation.

[Transrectal ultrasonography in the early diagnosis of prostate carcinoma: use of a new ultrasonography technique with endorectal probe]. / L'ecografia transrettale nella diagnosi precoce del carcinoma prostatico: utilizzo di una nuova manovra ecografica con sonda endorettale.

Seventy-80% of prostatic carcinoma develops in the peripheral gland. Transrectal ultrasound (TRUS) has the capacity to identify nodules or hypoechogenic areas in the peripheral zone, suspected to be carcinoma. We describe a new echographic technic with endorectal probe (target compression test), to study hypoechogenic areas or nodules in the peripheral gland, during TRUS examination. Thirty-three patients, aged 49-77 years, with prostatic peripheral hypoechoic lesion at transrectal ultrasound, were studied. All patients underwent prostatic biopsy. Ten of the 11 positive patients (non compressible lesion) at the target compression test resulted to be affected by adenocarcinoma. Only 3 of the 22 negative patients (compressible lesion) at the target compression test resulted to be affected by adenocarcinoma. Even if our data have to be confirmed by further studies, they suggest that the target compression test may be a useful complementary test, during TRUS, in the evaluation of hypoechogenic areas in the peripheral gland.

[Case report: Acro-necrosis of the upper limbs caused by gemcitabine therapy]. / Acronecrosi degli arti superiori da gemcitabina: segnalazione di un caso clinico.

INTRODUCTION: Even if infrequent, a digital necrosis after chemotherapy can occur in cancer patients. The gemcitabine is generally well tolerate; the cutaneous toxic ulcerations only in 0.3% of the cases induces the suspension of the treatment. CLINICAL CASE: A 70 year old patient, female, with a bladder cancer, after a trans-urethral resection, is submitted to adjuvant chemotherapy with Gemcitabine 1700 mg (total dose/die), with administration in the days 1st and 8th, while in the 15th day was not effected because, to distance of 3-4 days from the second administration, appear paresthesies of the fingers of the hands, together with Raynaud type phenomenon, 38-39 degrees C intermittent fever, digital necrosis and fingertips gangrene. Laboratory: (Normal): RF; AutoAb: AMA, ASMA, APCA, anti-DNA; ENA; lupus anti-coagulant; Ab-anti-cardiolipin; C3-C4, CIC; homocysteine, anti-thrombin, protein C, protein S, mutation of the factor V of Leiden, plasminogen, alfa 2-antiplasmin. (Altered): Auto-antibody: ANA (on Hep-2): positive (title 1/160, speckled pattern), cryoglobulin positive, ESR 29; Instrumental examinations: Superior Limbs Angiograpy: Occlusion of the digital arteries proper of 2nd, 3rd and 4th finger of the hands. Electromyography Inferior Arts: normal. Superior Arts: bilateral suffering of the median nerve at the carpal tunnel. Biopsy of the hand cutis: Hyperkeratosis, acanthosis and papillomatosis of the skin. Arterial vases with signs of endothelioangiitis and aspecific inflammation. CONCLUSIONS: Even if acronecrosis of the superior limbs is a rare effect of the gemcitabine, we would recommend particular caution in the administration of this drug in patient with known autoimmune disorders.

[Bile acids in the therapy of chronic liver diseases]. / Gli acidi biliari nella terapia delle epatopatie croniche.

In the last 10 years, interest about the employment of bile acids, especially of ursodeoxycholic acid (UDCA), in the treatment of chronic liver diseases has increased. The mechanism has not been completely explained yet, but this agent has been thought to act mainly by making bile less toxic for the liver cells, reducing the fraction of hydrophobic detergent bile acids. UDCA is effective in decreasing serum concentrations of liver enzymes in chronic liver diseases, especially in those associated with cholestasis. This effect discloses new perspectives about the employment of this agent, even in association with other drugs, i.e. interferon; however, further investigations will be necessary in order to standardize the use of UDCA in the treatment of chronic liver diseases.

[Medical therapy of portal hypertension due to liver cirrhosis]. / Terapia medica dell'ipertensione portale da cirrosi epatica.

Several vasoactive agents are known to reduce portal pressure and therefore are potentially useful in the treatment of portal hypertension. These drugs act in different ways and seem to have several actions. In most cases, their exact mechanisms have not yet been elucidated and more investigations are required. Different pharmacologic treatments of portal hypertension may result from these hemodynamic studies but more trials are required in the forthcoming years.

[The relations between atrial natriuretic factor release and adrenergic activation in hypertrophic cardiomyopathy]. / Relazioni tra rilascio di fattore natriuretico atriale ed attivazione adrenergica nella cardiomiopatia ipertrofica.

Atrial natriuretic factor (ANF) is a potent natriuretic and vasoactive (vasorelaxant) peptide localized in the secretory-like atrial specific granules. The main peptide in this storage granules is the 126 amino acid proatrial natriuretic peptide, but the principal circulating form in human plasma is the 28 amino acid, alpha-human natriuretic peptide. Animal and in vitro studies have suggested that ANF modulates autonomic circulatory control, probably with a dose-dependent mechanism. Moreover, recent human studies have resulted contradictory. In particular, it is still unclear if high circulating levels of ANF, which are present in congestive heart diseases constantly, may be correlated with sympathetic nervous system activity in man. Previously we have shown that in congestive diseases there is a relation between ANF and catecholamine secretion. From these basis, the aim of this study was to investigate on the pathophysiological relations between atrial natriuretic factor (ANF) release and adrenergic activation in patients with obstructive hypertrophic cardiomyopathy (n = 6) and non obstructive hypertrophic cardiomyopathy (n = 4). Sympathetic activation in physiologic way was induced by cycloergometer sub-maximal exercise. Then specimens of venous blood were achieved for plasma determination of ANF and catecholamines pre- and post-exercise. Results have shown that in obstructive hypertrophic cardiomyopathy patients basal levels of ANF and catecholamines were higher than levels of these parameters in non obstructive hypertrophic cardiomyopathy patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Detection of odorant molecules via surface acoustic wave biosensor array based on odorant-binding proteins.

In this paper, we present an array of biosensors for vapour phase detection of odorant molecules based on surface acoustic wave (SAW) resonators coated with odorant-binding proteins (OBPs). For the first time, the sensing capabilities of three different OBPs, as sensitive layers for SAW devices, are studied and compared. The SAW biosensor array is composed of three SAW devices coated by the droplet method with the wild-type OBP from cow (wtbOBP), a double mutant of the OBP from cow (dmbOBP) and the wild-type OBP from pig (wtpOBP). An uncoated device is used to compensate the variations of the environmental parameters. The SAW devices consist of two-port resonators fabricated on quartz (ST-cut, x propagation) with electrodes made of aluminium covered with a thin gold film (2 nm thick). The obtained surface densities of OBP layers are between 1.18×10(-6) kg/m(2) and 2.31×10(-6) kg/m(2) and were calculated measuring the resonant frequency shift of the SAW devices after the coating. The SAW biosensor array was tested in nitrogen upon exposure to vapours of R-(-)-1-octen-3-ol (octenol), in the range of concentration between 13 and 61 ppm, and R-(-)-carvone (carvone), in the range between 9 and 80 ppm. The highest sensitivity for detection of octenol (25.9 Hz/ppm) was obtained using the wtpOBP-based SAW biosensor, while the highest sensitivity for detection of carvone (9.2 Hz/ppm) was obtained using the dmbOBP-based SAW biosensor.

Characterization of the normal pulmonary surface and pneumonectomy space by reflected ultrasound.

Interest has been increasing in the use of transthoracic ultrasound for the study of the pleuropulmonary disease. US imaging depends mainly on the physical interactions between ultrasound waves and the tissues being examined. In the thoracic region, the prescence of the chest wall and the air-containing pulmonary tissues cause various artifacts that strongly influence the resulting images. At the interface between tissues and air, the ultrasound beam is totally reflected and produces simple reverberation, comet-tail artifacts, and ring-down artifacts.We report the findings of transthoracic ultrasound in normal healthy subjects and in those who had undergone pneumonectomy.This experience shows that, in terms of the ultrasound artifacts mentioned above, the postpneumonectomy cavity is not significantly different from the healthy lung.