Radiotherapy combined with erythropoietin for the treatment of extramedullary hematopoiesis in an alloimmunized patient with thalassemia intermedia.

We report a patient with thalassemia intermedia who developed a mediastinal syndrome due to the growth of paravertebral hematopoietic masses in the posterior mediastinum. Because the patient did not receive blood transfusions due to alloimmunization, she was first treated with human recombinant erythropoietin (escalating low-moderate doses) to recover hemoglobin levels, then in association with radiotherapy to prevent a worsening of her anemia. The mean Hb level dramatically increased and peaked at week 11, to 83 g/l, and remained unchanged before and after radiotherapy (81 versus 78 g/l). Immediately after radiotherapy extramedullary hematopoiesis volume decreased by 16.4%.

Venous angiomas: plain and contrast-enhanced MRI and MR angiography.

We studied 17 patients with venous angiomas, 4 of whom had associated cavernous angiomas. All underwent MRI with spin-echo T1- and T2-weighted images and T1-weighted images after Gd-DTPA; MR angiography (MRA) was also performed with 3D and 2D time-of-flight technique; 5 patients underwent conventional angiography. Contrast-enhanced MRI demonstrated all the lesions, showing the peripheral medullary veins, the collector and the type of drainage. Both 3D and 2D MRA provided diagnostic information identical to that obtained after infusion of Gd-DTPA. Contrast-enhanced were T1-weighted images and MRA superior in all the cases to images without gadolinium. The possible association with cavernous angiomas (24% in our study) indicates T2-weighted imaging.

[Gadolinium-DTPA dimeglumine administered orally for the study of the abdomen with magnetic resonance. Clinical evaluation and tolerance]. / Gadolinio-DTPA dimeglumina per uso orale nello studio dell'addome con risonanza magnetica. Valutazione clinica e della tollerabilità.

The tolerance to and the clinical value of a new positive oral contrast agent, Gd-DTPA-Dimeglumine, were evaluated. Ten healthy volunteers and 30 patients with abdominal and pelvic tumors were studied. Fourteen patients underwent MR scans only after cm administration, while 16 patients were examined both before and after. All images were obtained by means of a 1.5-T MR unit using SE and GE pulse sequences on the axial and coronal planes. Before the examination, a 1-mmol Gd-DTPA-Dimeglumine solution with mannitol and sodium citrate diluted in 1L of water was administered to all patients in 100-150-ml fractions. The product was well tolerated and its taste was good; adverse reactions were uncommon and mild. The solution was stable during gastrointestinal tract transit. Bowel signal was hyperintense on both GE and SE pulse sequences, which clearly demonstrated the bowel lumen distinguishing it from the surrounding fatty tissue and depicting even the smallest vascular structures. Moreover, from a clinical point of view, the hepatic, pancreatic and colic borders were better demonstrated in both normal and pathologic conditions.

Percutaneous treatment of hepatic cysts by aspiration and sclerotherapy.

We treated 35 patients who had hepatic cysts (30 congenital cysts, 5 hydatid cysts) with percutaneous puncture and sclerotherapy. After puncture and drainage of the cyst, a 95% alcohol solution was instilled as sclerosing agent into the cystic cavity. In all the patients, cyst puncture and drainage was successful. Follow-up in all cases was at least 12 months. In three uncooperative patients, cysts recurred due to incomplete sclerosis of the lining epithelium of the cyst wall. No major complications were encountered in all cases. All congenital cysts were treated on an outpatient basis. Patients with hydatid cyst were hospitalized for 48 h after puncture and aspiration. In our opinion, percutaneous drainage and sclerosis of congenital hepatic cysts can be considered an effective alternative to surgical treatment.

[Magnetic resonance angiography in the study of neoplastic cerebral pathology]. / L'angiografia con Risonanza Magnetica nello studio della patologia neoplastica cerebrale.

To date, magnetic resonance angiography (MRA) has been used in neuroradiology mainly to study vascular malformations and atherosclerotic changes of the carotid bifurcation. Our study was aimed at investigating the role of MRA with the time-of-flight technique in the study of intracranial neoplasms; a superconductive 1.5 T magnet was used, and FLASH and FISP 2D and 3D pulse sequences were acquired before and after Gd-DTPA administration. Fifty-five MRA examinations were performed. Our series consists in 32 meningiomas, 14 glial tumors, 3 hypophysis adenomas, 2 metastases, 1 NF2, 2 craniopharyngiomas, 1 lymphoma and 1 rhinopharyngeal carcinoma with intracranial involvement. In 27 patients MRA results were compared with DSA findings. The results showed high agreement relative to indirect angiographic patterns (dislocations, encasement, dural sinuses involvement) and poor accuracy in the demonstration of tumor vascularization (inflow and outflow, vascular neoformation).

Computed tomography detection of gastrointestinal neoplasms.

Gastrointestinal (GI) tract neoplasms can be detected, evaluated and staged by computed tomography (CT), especially from high-resolution examinations, but routine CT scanning may occasionally discover GI neoplasms in patients with non-specific symptoms. We therefore evaluated the sensitivity and main signs of CT examinations resulting from routine sessions. In 46 out of 1560 patients who underwent abdominal CT, it was possible to obtain a diagnosis of primitive gastric or colo-rectal tumour by means of barium X-ray and/or endoscopy. The sensitivity rate of CT obtained from the present study was 86% in gastric tumours and 87% in colonic tumours. In gastric lymphoma, infiltrating carcinoma of stomach and rectal carcinoma, the sensitivity rate was 100%. The CT diagnosis of GI neoplasms was based on diffuse or local thickening of the gut on a solid dishomogenous mass showing contrast enhancement. The prevalence of various patterns depends on site of origin and on macroscopic features of the neoplasia. In conclusion the results suggest that abdominal CT, even if performed with a method not specifically devoted to GI tract, has high sensitivity rates and then a high probability of detecting GI neoplasms when unsuspected at time of the examination. In our series 11% of GI neoplasms were initially diagnosed by routine CT examination.