Pharmacogenetics of oral antidiabetes drugs: evidence for diverse signals at the IRS1 locus.

To investigate the role of IRS1 locus on failure to oral antidiabetes drugs (OADs) we genotyped single-nucleotide polymorphisms (SNPs), rs2943641, rs7578326 (tagging all SNPs genome-wide associated with type 2 diabetes (T2D) and related traits at this locus) and rs1801278 (that is, the loss-of-function IRS1 G972R amino acid substitution) in 2662 patients with T2D. Although no association with OAD failure was observed for rs2943641 and rs7578326 SNPs (odds ratio (OR): 1.04, 95% confidence interval (CI): 0.93-1.16 and OR: 0.97, 95% CI: 0.87-1.09 respectively), a significant association was observed for rs1801278 (OR: 1.34, 95% CI: 1.08-1.66). When meta-analyzed with previous published data, an allelic OR of 1.41 (1.15-1.72; P=0.001) was obtained, so that homozygous R972R individuals have >80% higher risk of failing to OADs as compared with their G972G counterparts. In all, though further studies are needed for confirming this finding, our present data point to IRS1 rs1801278 as a potential biomarker for pursuing the goal of stratified medicine in the field of antihyperglycemic treatment in T2D.

[Ureteral jet in patients with benign prostatic hypertrophy: prognostic evaluation during single and combined therapy]. / Il jet ureterale nei pazienti con ipertrofia prostatica benigna: valutazioni prognostiche in corso di terapia singola e combinata.

By color-Doppler ultrasound it's possible to visualize urine flow jet from ureter into the bladder. Aim of the study was to evaluate of ureteral jet in patients with benign prostatic hyperplasia before, during and after with one or two drugs medical therapy. Thirteen patients, aged 51-63 years, were studied; they were not affected by metabolic, hepatic, renal diseases and by prostate inflammation. Eco color Doppler p.w. (Toshiba SSA 270A) with a convex probe of 3.5 MHz was used. A transabdominal ultrasound study was performed, prostate volume measured and ureteral jet visualized before and along treatment (at six months interval) with Finasteride and at the end of treatment. Successively, in four patients, with relapse of prostatic synptomatology, a transabdominal ultrasound study was performed, before and along a treatment with Finasteride, 5 mg/die (Finastid, Neopharmed) and Terazosin hydrochloride, 5 mg/die (Teraprost, Malesci), and at the end of treatment.

[Echohysterography in the diagnosis of female sterility: preliminary results]. / L'ecoisterografia nella diagnostica della sterilità femminile: risultati preliminari.

Couple's study infertility sometimes need repeated hysterosalpingographical evaluations. In three cases the A.A. value echohysterosalpingography's utility. The echohysterosalpingography gives morphological and functional dates, is easy repeatable and the patients aren't exposed to ionizing radiations.

[Urethral echography: potential and limitations]. / L'ecografia uretrale: possibilità e limiti.

Since in the early years of 1980, the diagnostic for images about male's urethral injury was exclusively assigned to urethrocystography. Sially in repeated check the gonads too often are exposed to ionizing radiations. Our results show urethrocystography/ultrasonography good correlation (13/15) cases) with 86% sensibility. Even if the urethrocystography is a methodic of first instance, the urethral ultrasonography is efficacious in follow up of urethral injury, particularly in the study of anterior urethra.

[Fast spin echo imaging of vertebral metastasis: comparison of fat suppression techniques (FSE-CHESS, STIR-FSE)]. / L'imaging Fast Spin Echo delle metastasi vertebrali: confronto tra tecniche di soppressione del grasso (FSE-CHESS, STIR-FSE).

PURPOSES: To investigate the capabilities of fast spin echo (FSE) sequences in diagnosing spinal metastases and to compare two fat-suppression techniques: CHESS (chemical shift selective saturation) and STIR (short T1 inversion recovery). Fat suppression is recommended with FSE sequences because on them, different from conventional spin echo (SE) sequences, fat has high signal intensity in both T1 and T2 weighting, masking such high-signal bone lesions as metastases. METHODS: Ninety metastatic lesions in 32 patients were studied with T1-weighted SE and T2-weighted FSE sequences with and without fat suppression (FSE-CHESS and STIR-FSE). Quantitative analyses (metastasis size, signal intensity, margins and conspicuity) and qualitative analyses (artifacts and fat saturation homogeneity) were carried out of both fat-suppression sequences. Signal-to-noise (S/N) and contrast-to-noise (C/N) ratios were calculated in 20 metastatic lesions. The results were analyzed with the chi 2 method and the paired t-test. RESULTS: Both fat-suppression FSE sequences were more sensitive to focal lesions (100%) than T1-weighted SE sequences (96.6%). Lesion signal was higher than that of surrounding bone in 95.5% of fat-suppressed images, which facilitated the recognition of spinal metastases. On the contrary, conspicuity was higher (73.3%) and the margins more definite (68.8%) on T1-weighted SE than on T2-weighted FSE sequences. Fat suppression was more apparent on STIR-FSE than on FSE-CHESS sequences, even with no significant difference in C/N ratio. CONCLUSION: Both STIR-FSE and FSE-CHESS sequences are rapid and useful techniques to obtain fat saturation in FSE images. CHESS saturation is selective on fat signal, while STIR suppresses the signal of all the substances with the same short T1 as fat.

Precision of sonographic measurement of articular cartilage: inter- and intraobserver analysis.

OBJECTIVE: To establish the precision of sonographic measurement of the thickness of the articular cartilage of the hip and knee in children. DESIGN: The precision was assessed by evaluating the intra- and interobserver variations in sonographic measurements. PATIENTS: A total of 65 healthy children were in the study. The articular cartilage of the right hip and knee of 40 subjects (mean age 10.3 years, range 4-16.9 years) was evaluated in masked fashion by two observers to assess the interobserver variability. The articular cartilage of the right hip and knee of 25 children (mean age 10.4 years, range 6.2-15.5 years) was examined twice by the same observer to assess the intraobserver variability. RESULTS AND CONCLUSIONS: Discrepancies between repeated measurements were expressed as data differences. The "limits of agreement" of data differences, i.e. the mean +2 SD and the mean -2 SD, ranged from -0.26 to +0.22 mm and from -0.56 to +0.48 mm for the interobserver analysis of the femoral head cartilage (FHC) and femoral condylar cartilage (FCC), respectively. The "limits of agreement" for the intraobserver analysis ranged from -0.16 to +0.15 mm and from -0.51 to +0.41 mm for the FHC and the FCC, respectively. The overall precision of the sonographic measurements was satisfactory. When used for determination of skeletal age, sonographic assessment of FHC thickness resulted in under/overestimation of skeletal age by about 7.5 months. In conclusion, sonographic measurement of articular cartilage is precise enough to be used in clinical practice.

[Diagnosis of mycoplasma pneumonia in children: which is the role of thoracic radiography?]. / La diagnosi di polmonite da mycoplasma nel bambino: quale il ruolo del radiogramma del torace?

Despite its frequency, pneumonia is often surprisingly difficult to diagnose in children and young adults. In particular, the etiologic agent of pneumonia is difficult to recognize in an early stage, which obviously implies an empirical or delayed treatment. Chest radiography is one of the most common procedures required when pneumonia is suspected. This retrospective study was carried out to investigate the capabilities of chest radiography to identify the specific patterns of mycoplasma pneumonia in children. The chest radiographs of 76 children and adolescents (aged 4.2 to 16.4 years) with a radiographic diagnosis of pneumonia were reviewed. All patients were tested twice for serum antimycoplasma antibodies. Thirty-eight subjects (50%) with markedly increased antimycoplasma antibody levels were diagnosed as having mycoplasma infection. In the remaining 38 patients, viral (22 patients, 29%), bacterial (13 patients, 17%) and mixed (3 patients, 4%) infections were diagnosed on the grounds of clinical and laboratory data. Parahilar peribronchial infiltrates were found to be associated with both viral and mycoplasma infections, whereas segmental or lobar consolidation was associated with bacterial, viral and mycoplasma infections. Reticulonodular infiltrates were a specific pattern of mycoplasma pneumonia. The authors conclude that, in the presence of a reticulonodular infiltrate in a lobe, mycoplasma pneumonia can be confidently diagnosed.

[Treatment of primary hepatocarcinoma with chemoembolization and alcohol injection. Personal experience]. / Trattamento dell'epatocarcinoma primitivo mediante chemioembolizzazione e alcolizzazione. Esperienza personale.

The comparative efficacy of transcatheter arterial chemoembolization and percutaneous ethanol injection (PEI) in the treatment of hepatocellular carcinoma (HCC) was investigated in a series of 243 consecutive patients: 146 of them were submitted to 1-6 chemoembolization sessions at 1 and 3 months' intervals and 30 to PEI; the remaining 67 patients refused any treatment. The follow-up ranged 3 to 36 months. Survival rates were statistically analyzed with the life table analysis. Patients' survival was affected by the number of nodules and by Child's and Okuda's classes; no relationship was found between survival rates and histologic grade or nodule vascular feeding. In case of single lesions, chemoembolization was more effective than PEI in Okuda's class I. In case of multifocal HCC, chemoembolization was better than no treatment in Okuda's class I and Child's class A. In conclusion, we suggest chemoembolization as the treatment of choice in Child A or Okuda I patients with multifocal HCCs, while its use seems of little help in Child B-C or Okuda II-III patients. In case of unifocal HCC, PEI or surgical resection should be combined with chemoembolization.