[Diagnostic imaging of gastrointestinal leiomyosarcoma. Experience with 12 cases]. / Diagnostica per immagini del leiomiosarcoma con localizzazione gastrointestinale. Esperienza in 12 casi.

PURPOSE: Gastrointestinal (GI) leiomyosarcoma is an uncommon malignant cancer arising in the smooth muscle of the alimentary tract. It is known for its widely variable patterns and aspecific symptoms and signs preventing correct clinical assessment in the majority of cases. We will illustrate the key role of diagnostic imaging in the detection and staging of this lesion, describing the most suggestive imaging findings for the correct diagnosis. MATERIAL AND METHODS: January, 1990, to June, 1998, we examined 12 patients with GI leiomyosarcoma; they were 10 men and 2 women whose age ranged 42 to 85 years (mean: 63.7 years). Four lesions were found in the stomach, 3 in the jejunum and ileum, and 2 in the rectum. Due to the difficult clinical assessment of this type of lesion and to the development of emergency conditions, we could plan no diagnostic protocol in advance; thus, the most suitable diagnostic imaging approach was decided on the spot for studying the supposedly involved GI portions. Double contrast studies, US, CT and endoscopy were performed and each patient underwent at least two examinations. RESULTS: Barium contrast studies were performed in 9 patients: the lesion was detected in 7 cases and tumor site and extent were defined in 5, while the double contrast study of the colon allowed to exclude large bowel involvement in 2 ileal tumors. In all 9 cases US and US-guided endoscopy permitted better assessment of extra-luminal spread and involvement of adjacent organs. CT, which is essential to staging, provided useful information suggesting the lesion nature: a round, inhomogeneous mass in continuity with the intestinal wall, with irregular margins, peripheral enhancement after i.v. injection of contrast material and a central necrotic area. Histology confirmed CT diagnosis in 7/9 cases while an aspecific diagnosis of large retroperitoneal and abdominal lesion was made in 2 cases. CT did not allow to define the origin of 2 large exophytic lesions in the stomach and jejunum and missed peritoneal metastases in 3 cases. CONCLUSIONS: Although the aspecific and quite variable clinical patterns make it extremely difficult to plan a correct diagnostic protocol, in our experience all diagnostic imaging techniques played a fundamental role in identifying and staging alimentary tract leiomyosarcoma. Particularly, CT showed high sensitivity and specificity in characterizing and staging this lesion but exhibited rather poor sensitivity in recognizing peritoneal spread.

Incidence and clinical study of ectopic erythropoiesis in adult patients with thalassemia intermedia.

We carried out total body computerized tomography (CT) studies and examined the retrospective clinical data of 29 adult patients with thalassemia intermedia (TI) to evaluate the incidence, features and pathogenesis of ectopic erythropoiesis (EE), located chiefly at the paravertebral gutters in the thorax, was present in 65.5% of the patients; 15% of them had severe clinical complications. We found a clear relationship between EE development and early presentation age of thalassemia, splenectomy and the presence of 100% fetal hemoglobin. The frequent occurrence of EE suggests that CT screening of patients with thalassemia intermedia should be mandatory. We also recommend radiotherapy as a preventive measure for the clinical complications of thalassemic patients with EE.

Anatomic variations of surgical importance in ethmoid labyrinth and sphenoid sinus. A study of radiological anatomy.

The present study was performed on axial and coronal CT scans of 100 patients, most of whom were affected by nasal polyposis. Five observers had to analyse the radiograms and answer a questionnaire including the following items: presence of a supraorbital recess; identification of anterior and posterior ethmoidal canals; dehiscences in the lamina papyracea; pneumatized middle turbinate; presence of a sphenomaxillary plate; presence of Haller's cells; presence of Onodi's cells; relationships of the optic canal; relationships of the internal carotid artery; relationships of the maxillary nerve; relationships of the vidian nerve; level difference between the ethmoid roof and nasal vault; depth of the sphenoethmoidal recess. The data obtained were compared with those drawn from anatomical studies. The fair agreement between them proves the value of CT as an alternative method for studying paranasal sinuses anatomy.

[Transluminal urethroplasty. Preliminary experience in 15 cases]. / Uretroplastica transluminale (TUP). Esperienze preliminari su 15 casi.

Thirteen patients with urethral stenoses of different etiopathology underwent TUP with an angioplasty balloon catheter. At follow-up, more than 10 months later, 8 out of 10 patients had normal urinary function. Excluding cases of urethral compression due to prostatic hyperplasia, 90% of the stenoses were successfully dilated. The gradualness of the dilatation, the application of a Foley catheter to maintain the dilatation obtained and the prevention of urinary infections are important factors for the success of this method.

[Role of ultrasonic tomography in the diagnosis of prostatic cysts. Our experience in l3 cases]. / Il ruolo dell'ecotomografia nella diagnosi delle cisti prostatiche. Nostra esperienza in 13 casi.

Authors describe the radiological and echographic methods of investigation of cystic structures in the prostate, remarking the great importance of echotomography. They relate upon their experience in 13 cases of prostatic cyst, a pathological condition which is still poorly known.

[Angio-CT in the staging of renal carcinoma]. / L'angio-TC nello staging dei carcinomi renali.

The authors report the results about the staging of renal carcinoma using "angio-CT". The diagnostic accuracy, the sensibility, the specificity, in 42 patients, have been evaluated and compared with the subsequent operative or authoptic diagnosis. The meaning of this study is the comparison of the results obtained by this method in front of other examinations, especially artheriography.

[Angioplasty of the renal arteries. Our experience with a 12-month follow-up]. / Angioplastica delle arterie renali. Nostra esperienza con un follow-up di 12 mesi.

We have treated 56 stenoses of renal arteries in 50 patients in which a renin assay indicated renovascular hypertension. In this paper we refer only to 40 cases of renal arteries angioplasty in 37 patients (3 cases of bilateral stenoses) with a clinical follow-up of 12 months. 25 lesions were of arteriosclerotic nature, while 15 were due to fibromuscular displasia. Results demonstrated that angioplasty resolved hypertensive conditions (either with or without medical therapy) in 82% of the cases of arteriosclerotic lesions and in 86% of the stenoses due to fibromuscular displasia. Although extremely rare, the complications that may occur with this procedure are very serious (arterial rupture, acute thrombosis, peripheral embolization). Out of utmost importance is a close collaboration with a vascular surgeon. Without doubt angioplasty will bring about radical changes in the preparation of therapeutical protocol and in some selected cases to improve renal function.