Magnetic resonance imaging in the complications of kidney transplantation.

Kidney transplantation is currently the treatment of choice in most patients with end-stage chronic renal failure owing to the excellent results in terms of both graft and patient survival. However, surgical complications are still very frequent. Although urological (stricture, urinary fistulas, vesico-ureteral reflux) and lymphatic complications (lymphocoele) have a high incidence, they only rarely lead to graft loss. By contrast, vascular complications (stenosis, arterial and venous thrombosis, arterio-venous fistulas, pseudoaneurysms) are relatively rare, but potentially serious and may affect graft survival. Finally, medical complications such as acute tubular necrosis (ATN), rejection and de novo neoplasms may also arise in kidney transplantation. The purpose of this pictorial review is to illustrate the increasingly significant contribution of magnetic resonance angiography (MRA) in the management of complications of kidney transplantation, and emphasise how this method should now be considered a mandatory step in the diagnostic workup of selected cases. Moreover, the application and role in this setting of new magnetic resonance imaging (MRI) techniques, such as diffusion-weighted and blood oxygen level-dependent (BOLD) MRI, are also discussed.

Critical issues in radiology requests and reports.

PURPOSE: This study evaluated the appropriateness and accuracy of 500 radiology requests and their matched reports in order to identify recurring errors in both areas. MATERIALS AND METHODS: A randomly chosen sample consisting of 167 computed tomography (CT), 166 ultrasonography (US) and 167 radiographic examinations were collected and analysed according to national referral guidelines and to the principles of justification and optimisation (Law no. 187/2000). RESULTS: We identified a high rate of inappropriate requests (27.6%) and requests lacking a clinical question (22%). There was good precision in the anamnestic data (80.6%) and in the formulation of the diagnostic question (76.8%). Almost all requests were handwritten, and 12.5% lacked the referring physician's stamp and/or signature. No report mentioned the clinical information received or the equipment used. The use of contrast medium was always reported. Conclusions were reported in 9.8% of these reports. When further investigation would have been necessary, the radiologist omitted to report this in 60% of cases. CONCLUSIONS: Some important weaknesses emerged, especially regarding requests for radiological examinations (22% lacked the clinical question, 27.6% were inappropriate), potentially limiting the effectiveness of the diagnostic process and leading to negative effects on the correct risk management process. There emerges a need for better collaboration between clinicians and radiologists.

[Preliminary results on the effects of pretreatment with thymic extract on experimental endotoxin hepatitis in the mouse]. / Risultati preliminari sugli effetti di un pretrattamento con estratto timico nell'epatite sperimentale da endotossina nel topo.

The Authors wish to examine the protective effects which a period of pre-treatment with thymostimulin, would have on endotoxin hepatitis, induced in thymectomized and non-thymectomized animals. The test showed that the histological picture and the degree of endotoxinemia, measured with the Lymulus test, benefited from treatment with a thymic extract. This therapy was effect (and was statistically significant) in obtaining an immunorestoring effect (in the thymectomized mouse) and in inducing an immunostimulating effect (in the normal mouse).

[Mycoplasmas and dysplasia of the uterine cervix]. / Micoplasmi e displasie della portio uterina.

The Authors report a case-list of 395 patients vaginal specimens who were never treated with chemo-antibiotic therapy. Cell dysplastic impairments were found in 213 cases. About these dysplastic alterations, 133 are of slight type, 53 intermediate type and 27 are in advanced phase. We can say, about the last 27 cases, that the concomitance of pH greater than 6.1 in 67% of the cases and the absence of Lactobacillus acidophilus in 81.4% of the cases is not casual. Furthermore, we can notice that vaginal pH suffers an increase in dysplastic patients with a smaller colonization with Lactobacillus acidophilus that, in dysplastic advanced phase is absent in 81.4% of the cases. It is also to remark a significant increase of cases Trichomonas-positive and Mycoplasmas-positive in dysplastic patients, as compared with normal women. The results of the case-list, even if preliminary, seem to be indicative for an evolution of the studies on the relationship between uterine cervix cells and Mycoplasmas and eventual possibility the Mycoplasmas can act as carriers of oncogenic viruses such as Herpes and Papova Virus.

Low-density-lipoprotein peak particle size in a Mediterranean population.

BACKGROUND: The predominance of small, dense low-density lipoprotein (LDL) particles ('LDL phenotype B') has been associated with a three-fold increased risk of myocardial infarction, but the feasibility of the identification of small, dense LDL as independent predictors of coronary artery disease risk in population studies remains questioned. Design We evaluated the LDL peak particle size and its relation with other established risk factors for coronary heart disease in a group of 156 randomized subjects living on the Mediterranean island of Ustica (71 males and 85 women, range of age 20-69 years), representing approximately 30% of the total population. RESULTS: The prevalence of LDL phenotype B subjects was low (approximately 15% in both men and women) and there was a clear trend for both genders in reducing the LDL peak particle size with age. Moreover, LDL phenotype B subjects had higher BMI values, prevalence of diabetes and plasma triglyceride (TG) levels and lower plasma HDL-C concentrations in comparison with LDL phenotype A individuals; in a multivariate analysis, plasma TG levels were the only variable independently associated with LDL peak particle size. CONCLUSIONS: In this population, which appears to be somewhat protected by premature coronary artery disease, a low prevalence of the LDL pattern B was found in both men and women, and plasma TG could have a key role in regulating the LDL peak particle size. The follow up, still ongoing, will provide useful information on the predictive role of LDL peak particle size on cardiovascular risk, at least in a low-risk population.