Usefulness of chemical-shift MRI in discriminating increased liver echogenicity in glycogenosis.

BACKGROUND: Glycogen storage diseases are inherited defects which cause accumulation of glycogen in the tissues. Hepatic steatosis is defined as accumulation of fat within hepatocytes. On sonography, liver shows increased echogenicity both in glycogen storage diseases and steatosis. Liver hyperechogenicity in glycogen storage diseases may depend on accumulation of glycogen and/or fat. Chemical-shift magnetic resonance imaging can discriminate tissues only containing water from those containing both fat and water. AIM: The primary aim of the present study was to evaluate the usefulness of liver chemical-shift magnetic resonance imaging for detecting liver steatosis in patients with metabolic impairment due to glycogen storage diseases. SUBJECTS: Twelve patients with type I (n=8) or type III (n=4) glycogen storage diseases were studied and compared to 12 obese-overweight subjects with known liver steatosis. As control group 12 lean normal voluntary subjects were recruited. METHODS: Liver was evaluated by sonography and chemical-shift magnetic resonance imaging to calculate hepatic fat fraction. RESULTS: A significant difference in echogenicity between patients with glycogen storage diseases and normal subjects was observed (p<0.05), while this difference was not present between overweight-obese and glycogen storage diseases patients. On the contrary, fat fraction was similar between glycogen storage diseases patients and normal subjects and different between glycogen storage diseases patients and overweight-obese (p<0.05). CONCLUSION: The present data suggest that chemical-shift magnetic resonance imaging may exclude fat deposition as a cause of liver hyperechogenicity in subjects with glycogen storage diseases.

Proteomic analysis of rat hippocampus after repeated psychosocial stress.

Since stress plays a role in the onset and physiopathology of psychiatric diseases, animal models of chronic stress may offer insights into pathways operating in mood disorders. The aim of this study was to identify the molecular changes induced in rat hippocampus by repeated exposure to psychosocial stress with a proteomic technique. In the social defeat model, the experimental animal was defeated by a dominant male eight times. Additional groups of rats were submitted to a single defeat or placed in an empty cage (controls). The open field test was carried out on parallel animal groups. The day after the last exposure, levels of hippocampal proteins were compared between groups after separation by 2-D gel electrophoresis and image analysis. Spots showing significantly altered levels were submitted to peptide fingerprinting mass spectrometry for protein identification. The intensity of 69 spots was significantly modified by repeated stress and 21 proteins were unambiguously identified, belonging to different cellular functions, including protein folding, signal transduction, synaptic plasticity, cytoskeleton regulation and energy metabolism. This work identified molecular changes in protein levels caused by exposure to repeated psychosocial stress. The pattern of changes induced by repeated stress was quantitatively and qualitatively different from that observed after a single exposure. Several changed proteins have already been associated with stress-related responses; some of them are here described for the first time in relation to stress.

Clinical pharmacokinetics of cefotaxime and penetration in sputum, bone, and prostatic tissue.

Cefotaxime is a new powerful methoxycephalosporin with a broad anti-microbial spectrum, suitable for parenteral administration. In the present study, the concentrations of cefotaxime in serum and in bronchial secretion were determined after intramuscular injection of 1 gm every eight hours for seven days. Subjects were patients suffering from an exacerbation of chronic bronchitis. Serum levels versus time curve were interpreted in terms of a one-compartment open model. Pharmacokinetic parameters after single and multiple doses were investigated. No evidence of significant accumulation was found. Furthermore, a type of in vivo rate of killing with cefotaxime was investigated by evaluating the decrease in the number of colonies in bronchial mucus cultures daily for seven days. In two groups of volunteers who had to undergo surgery, bone and prostatic concentrations of cefotaxime were determined and correlated with serum levels.

Cardiac autonomic responses to intermittent social conflict in rats.

Intermittent exposure to the same stressor can lead to a gradual decline in physiological, neuroendocrine and behavioral stress responses (habituation). We investigated possible habituation of cardiac autonomic responsiveness and susceptibility to cardiac arrhythmias in male rats exposed to either intermittent social victory (VIC) or defeat (DEF) stress (10 exposures in each case). Electrocardiograms were recorded via radiotelemetry and the sympathovagal balance at the level of the heart was evaluated via time-domain measurements of heart rate variability, namely average R--R interval (average time interval between two consecutive heart beats, RR), the standard deviation of RR (SD(RR)) and the root-mean-square of successive R--R interval differences (r-MSSD). Values of these parameters were significantly lower in DEF as compared to VIC rats in the second part of the test period (from Minute 6 to Minute 15), suggesting a more pronounced sympathetic dominance in the former group of animals. Accordingly, the occurrence of the most frequent cardiac arrhythmias (ventricular and supraventricular premature beats) was higher in DEF rats. Habituation of cardiac autonomic responsivity was observed across repeated exposure to victory, both in terms of sympathovagal balance and susceptibility to cardiac tachyarrhythmias, whereas no habituation was found in repeatedly defeated animals. A possible explanation to this discrepancy could be the different degree of controllability characterizing the two social challenging situations.

Cardiac and pulmonary calcification in a hemodialysis patient: partial regression 4 years after parathyroidectomy.

AIMS: The reversibility of extraskeletal calcifications in dialysis patients is an important and unresolved issue. Although periarticular calcifications have been shown to be reversible, little data are available on vascular or parenchymal calcifications. CASE HISTORY: A patient on maintenance hemodialysis with severe hyperparathyroidism, hypercalcemia and hyperphosphatemia was admitted to undergo parathyroidectomy. A preoperative total body bone scintigraphy was performed to better evaluate a lytic lesion in the pelvis, the histology of which proved to be a "brown tumor". The scan showed the typical findings of renal osteodystrophy, but also a diffuse extra-skeletal uptake of bone tracer in the lungs, kidneys, femoral arteries and myocardium. After surgery, good control of serum calcium, phosphate (Ca x P product < 50 mg2/dl2) and PTH levels was maintained during 4 years of follow-up. Bone scans were repeated after 2 and 4 years, showing marked improvement of periarticular uptake at the ends of long bones. Extraosseous calcium deposition was still markedly evident, but progressively decreased (at 4 years: heart -36%, lungs -18%). CONCLUSION: In this dialysis patient, extraskeletal calcification of visceral organs (particularly in the heart and the lungs) due to prolonged hypercalcemia and hyperphosphatemia was partially reversible by parathyroidectomy followed by good long-term control of serum phosphate and calcium.

Abdominal ultrasonography in inheredited diseases of carbohydrate metabolism.

PURPOSE: To determine the usefulness of abdominal sonography in inherited diseases of carbohydrate metabolism. MATERIALS AND METHODS: Thirty patients (age range, 4 months to 27 years) with glycogen storage diseases, galactosemia, disorders of fructose metabolism were studied with sonography. Echogenicity of the liver, sonographic dimensions of liver, kidneys and spleen were evaluated. Plasma blood parameters (ALT, AST, total cholesterol, triglycerides) were determined. RESULTS: Liver was enlarged in 21/22 patients (95.4%) with glycogen storage diseases, in both subjects with disorders of fructose metabolism, and in 2/6 patients (33.3%) with galactosemia. Hepatic echogenicity was increased in 20/22 patients (90.9%) with glycogen storage diseases, and in the subject with hereditary fructose intolerance. Patients with galactosemia did not show increased liver echogenicity. Both kidneys were enlarged in 8/17 patients (47.0%) with glycogen storage disease type I. Subjects with increased hepatic echogenicity exhibited higher plasma concentrations of any blood parameter than the others with normal echogenicity (p<0.05). CONCLUSIONS: Sonography can be useful in identification of inherited diseases of carbohydrate metabolism even if further examinations are necessary for an ultimate diagnosis.

Acute posttraumatic rupture of the thoracic aorta: the role of angiography in a 7-year review.

Between 1983 and 1989, 15 patients with acute rupture of the thoracic aorta by blunt trauma were seen. Superior mediastinal widening and obscuration of the aortic arch were the most important findings on chest radiograph. Computed tomography examinations in 7 patients showed mediastinal hematomas but did not reveal aortic lesions. Definitive diagnosis of traumatic aortic rupture was established by aortography in all 15 patients. Intraarterial digital subtraction angiography proved to be as accurate as conventional film aortography and saved time.

[Efficiency of tetracaine in digital angiography of the blood vessels of the neck]. / Efficacia della tetracaina nell'angiografia digitale dei vasi del collo.

Deglutition artifacts often degrade diagnostic quality in digital subtraction angiography (DSA) of neck vessels. In order to reduce this drawback, the authors gave a local anesthetic (Tetracaine) to the patients undergoing DSA of aortic arch and carotid arteries. Hundred-twenty-three subjects divided into two groups were examined: Tetracaine was administered to one group (64 patients) and not to the other (59 cases). In the first group deglutition artifacts were not noted in 59/64 cases. Among those patients not treated with Tetracaine/deglutition artifacts were absent in 45/59 cases. This local anesthetic did not produce important toxic reactions. Therefore the authors believe that administration of local anesthetics can reduce deglutition artifacts in DSA of neck vessels.

[Comparison of portal CT, arterial CT and CT with intravenous contrast media in the diagnosis of hepatocarcinoma]. / Confronto tra porto-TC, arterio-TC e TC con mezzo di contrasto per via endovenosa nella diagnosi dell'epatocarcinoma.

Sixty-nine patients underwent CT for hepatocellular carcinoma (HCC). All subjects were examined with CT before and after bolus injection of contrast medium: 42 HCCs were detected. 13/42 patients underwent also CT arteriography (contrast medium in the hepatic artery) and 29/42 were submitted to CT during arterial portography (contrast medium in the superior mesenteric artery). The results of the three techniques were compared with each other and with surgical and pathologic findings. CT during arterial portography detected other lesions in 5/29 patients while it confirmed CT diagnosis in the extant 24 cases; CT arteriography recognized other lesions in 2/13 subjects while in the extant 11/13 it confirmed CT diagnosis. Both CT arteriography and CT during arterial portography affected treatment protocol in 16.2% of cases. The results had surgical confirmation in all patients but 3 in whom intraoperative US showed some nodules undetected earlier. All the lesions were hypodense on CT during arterial portography. On CT arteriography, they were hyperdense in 4/13 cases and hypodense with an irregular hyperdense halo in 9/13 cases. To conclude, CT during arterial portography and CT arteriography are better diagnostic tools than CT: nevertheless, they are invasive techniques and should be employed in selected cases only.

Anthropometric or ultrasonic measurements in assessment of visceral fat? A comparative study.

The main aim of the study (study 1) was to compare the accuracy of anthropometric and ultrasonic measurements in assessing the amount of visceral adipose tissue. An additional aim (study 2) was to verify ultrasound technique precision. Study 1: using computed tomography (CT) L4-L5 adipose tissue area as a gold standard we compared the accuracy of waist/hip circumference ratio, sagittal diameter and ultrasonic measurements of intra-abdominal depth in assessing the amount of visceral adipose tissue. Study 2: ultrasonic measurements of the intra-abdominal muscle-vertebra distance were made in triplicate by three different operators. In study 1, 24 volunteers were used; body mass index (BMI): 19-43. In study 2, 22 volunteers were used; BMI 20-42. In study 1, ultrasonic measurements of the abdominal depth correlated best with CT visceral adipose tissue area (r = 0.89 - 0.91). In study 2, inter-operator and intra-operator mean variation coefficients were about 7% and 5% respectively. We concluded that using a well standardized technique and properly trained operators, ultrasonic measurement of intra-abdominal depth is a valid method in assessing the amount of visceral adipose tissue.

[Comparison between portography-CT and lipiodol-CT in the staging of hepatocellular carcinoma]. / Confronto tra porto-TC e lipiodol-TC nella stadiazione del carcinoma epatocellulare.

Eighteen patients (13 men and 5 women) with uni- and multifocal hepatocellular carcinomas (HCC) were examined. Mean patients age was 63.3 years (range: 47-74 years). All patients had alcoholic or posthepatitis cirrhosis; they were submitted to both CT during arterial portography (APCT) and Lipiodol-CT. The diagnosis of HCC was confirmed by fine-needle biopsy (FNB) in all cases. APCT and Lipiodol-CT results were compared for number, size and site of lesions-32 lesions in all. APCT demonstrated all the lesions: 9 of them were smaller than 2 cm, 14 ranged 2-5 cm and 9 were bigger than 5 cm; moreover, APCT demonstrated other lesions in 3/18 patients (16.6%) which had been missed by US, CT and angiography. Also Lipiodol-CT demonstrated all the 32 lesions and showed smaller lesions in 4/18 patients (22.2%); these nodules were smaller than 2 cm. Based on APCT results 11/18 patients (61.1%) were considered operable, vs. 7/18 patients (38.8%) based on Lipiodol-CT results. To conclude, both APCT and Lipiodol-CT are useful in the preoperative staging of HCC; Lipiodol-CT is preferable to APCT in the study of lesions smaller than 2 cm.

[Radiographic enlargement in the study of hand diseases. Digital versus conventional techniques]. / L'ingrandimento radiografico nello studio delle malattie della mano. Tecniche digitale e tradizionale a confronto.

The electronic magnification of digital images was compared with direct digital magnification and with plain radiograph magnification. A whole-body computed radiographic system with photostimulable phosphor plates contained inside standard X-ray cassettes was used. The small bones of the hands and wrists of 18 patients with traumatic (10 cases) or degenerative (8 cases) bone conditions mainly due to chronic renal failure were studied. Each patient was examined with all three techniques: the images were retrospectively reviewed by four observers relative to resolution, contrast, visibility of the lesions and diagnostic value of each method. The statistical analysis of our results demonstrated better yield of direct digital magnification than of plain radiograph (p = 0.00043) and of electronic (p = 7.5 10(-13) magnification. This finding was mainly due to density and contrast optimization of digital images, in spite of their low spatial resolution. This feature allows good simultaneous representation of structures with different radiographic densities, as it happens in the hand and wrist. Electronic magnification yielded less brilliant results, even if compared with plain radiographic studies (p = 0.0032). However, this limitation was compensated for by the fact that this technique is easier and quicker to perform and that it does not require any additional X-ray exposure.

[Abnormalities of the hepatic artery++ in relation to portal hypertension surgery. Study with angiography and echography]. / Le anomalie dell'arteria epatica in relazione alla chirurgia dell'ipertensione portale. Studio con angiografia e ecografia.

This study was aimed at investigating the occurrence of hepatic artery variants, at comparing the diagnostic value of duplex Doppler US with that of angiography, and at correlating the results with the technical problems in portal hypertension surgery. All patients were studied with angiography, conventional and duplex Doppler US. In 162 patients with portal hypertension, 38 hepatic artery variants (23.4%) were observed and classified according to Michaels. The commonest variant recognized by angiography was right hepatic artery arising from superior mesenteric artery (type III according to Michaels). US demonstrated hepatic artery variants in 9/162 patients (5.5%). At surgery, variants were found in 3/162 subjects (1.8%) and caused surgical problems in 2 of them (1.2%) - i.e., right hepatic artery arising from superior mesenteric artery. Arteriography is still the best examination to depict hepatic artery variants, while duplex Doppler US demonstrates only a few types. Moreover, the number of variants detected by imaging techniques (23.4%) differs greatly from that observed at surgery (1.8%). Finally, hepatic artery variants are not correlated with surgical problems, nor can the latter be foreseen by imaging methods. US is useful but not essential to detect hepatic artery variants which are subsequently confirmed by angiography.

[Role of computed tomography in splenic blunt trauma]. / Il ruolo della Tomografia Computerizzata nei traumi chiusi della milza.

The CT scans of 18 patients (12 males and 6 females; mean age: 43.6 years) with splenic blunt trauma were reviewed. CT examinations had been made at different times after trauma. The CT images were grouped according to the time of examination and both structure and densitometry were evaluated in all lesions. In all cases CT findings were correlated with surgical and pathologic data. The patients were divided into two groups: group I included 11 subjects in whom CT had been performed within 48 hours following trauma and group II included 7 patients who had undergone CT at different times after trauma (3-13 days; mean: 6.5 days). All the lesions in group I exhibited blurred outlines, while the lesions in group II had clear-cut margins. The lesions in group I were always hyperdense while those in group II were hypodense. CT diagnosis was always in agreement with surgical findings. In conclusion, we confirm the value of CT in the examination of splenic lesions by blunt abdominal trauma. The evolution of splenic lesions is usually typical: CT yields useful information for injury evaluation and is therefore very important to plan treatment. We believe that CT should be performed as soon as possible, even on the basis of minor clinical and laboratory data.