[Role of magnetic resonance in hemodialysis patients with amyloid shoulder arthropathy]. / Il ruolo della Risonanza Magnetica nell'artropatia della spalla da amiloidosi nei pazienti emodializzati.

PURPOSE: Amyloid shoulder arthropathy is a frequent finding in long-term hemodialysis patients. Assessing the symptoms is fundamental in the approach to these patients but their long life expectancy means that the correct imaging quantification of scapulohumeral joint impairment is just as important. We investigated the role of MRI in amyloid shoulder arthropathy in long-term hemodialysis patients. MATERIAL AND METHODS: From January, 1995, to December, 1996, twelve long-term (mean: 13 years) hemodialysis patients with amyloid shoulder arthropathy were examined with MRI. All of them had undergone physical examination to detect the most involved scapulohumeral joint. MRI was carried out with a 1.0 T Magnetom Impact unit (Siemens, Germany) using T1-weighted Turbo SE sequences at high resolution on coronal and sagittal planes, respectively parallel and perpendicular to the supraspinatus tendon, and FLASH sequences on the axial plane. Six patients were then submitted to surgery. RESULTS: MRI had identified 3/12 rotator cuff tears (always involving the supraspinatus tendon and other tendons), 7/12 rotator cuff tears from supraspinatus tendon injury, and 1/12 thickening and structural dishomogeneity of the supraspinatus tendon. Finally, no structural changes were shown in 1/12 cases. In addition, most MR examinations (11/12) showed some inhomogeneous material characterized by intermediate-to-low signal intensity on T1-weighted sequences; such changes were found in subacromial and subdeltoid bursas in part of the articular capsule and were always associated with hypointense nodular images in all sequences. Surgery was carried out in 6 patients and confirmed both the structural changes of the rotator cuff and the presence of amorphous material which appeared to be amyloid deposits at subsequent histology. MRI proved to be a very reliable tool even in the study of skeletal structural changes, permitting both the identification of periarticular calcifications and the accurate analysis and quantification of subchondral erosions. CONCLUSIONS: MRI was a very reliable tool not only in the study of rotator cuff tears due to amyloid deposition but also in the analysis of bone changes. Thus MRI could play a growing role in treatment planning.

[Criteria for utilization and indications for use of permanent and short- and medium term temporary endocaval filters. Personal experience and review of the literature]. / Criteri dell'utilizzazione e indicazioni all'uso dei filtri endocavali definitivi e temporanei con durata breve e media. Esperienza personale e revisione della letteratura.

Screening and prophylaxis of the population at risk is the most correct approach to thromboembolic disease. Caval filters play a major role in the prevention of pulmonary embolism, but their use remains widely controversial, even if they are an alternative or additional method to medical therapy and not antithetical to it. July, 1990, to September, 1995, seventy-seven permanent vena cava filters (59 LGM, 13 Filcard and 5 titanium-Greenfield), 22 short-duration temporary vena cava filters (11 LGT, 6 Filcard, 3 Filcard-Emanuelli and 2 Lysofilter) and 10 mid-duration temporary vena cava filters (Tempofilter) were inserted in 109 patients (55 men and 54 women) aged 17-88 years. An inferior vena cavogram was always made before filter insertion to "map" the inferior vena cava and its tributaries (renal veins) and to assess caval size. This is a mandatory step to exclude or confirm the presence of endocaval thrombi. Sixty-eight filters were inserted percutaneously via a right internal transjugular approach, 40 via a common transfemoral approach (34 right and 6 left) using the same route as inferior cavography and digital pneumoangiography. One temporary filter was inserted via a right transhumeral approach. Sixty-three patients (57.8%) (44 with a permanent filter, 14 with a temporary filter and 5 with a Tempofilter) had medical diseases, 7 patients (6.4%) (4 with a permanent filter, one with a temporary filter and 2 with a Tempofilter) had surgical conditions; 10 patients (9.2%) (7 with a permanent filter and 3 with a Tempofilter) were surgical-orthopedic patients. Twenty-seven patients (24.8%) (22 with a permanent and 5 with a temporary filter) had cancer. Two patients (1.8%) with a temporary filter were breast feeding. All the patients had deep venous thrombosis of the lower limbs, including the inferior vena cava and the right renal vein in two patients. A proximal floating thrombus and a pulmonary thromboembolism was diagnosed in 41 (37.6%) and 34 (31.2%) cases, respectively. The temporary filters remained in situ 1-4 days and the Tempofilters 3-5 weeks. A pelvic hematoma developed (because of heparin?) after the insertion of a temporary filter and a Tempofilter branch detached and migrated into a lower branch of the left pulmonary artery were reported as immediate and short-term consequences. There were no early or late consequences for the patients. An axillary hemorrhage was observed in the site of previous surgery, during fibrinolysis with a Lysofilter, as well as the incomplete opening of a titanium-Greenfield filter and of two permanent LGM filters, partly trapped within endocaval thrombi. No further consequences to the patients due to permanent filters were observed, nor any case of symptomatic pulmonary thromboembolism, in patients with permanent or temporary filters. With reference to the relative literature and to their own experience, the Authors propose a detailed and rational synthesis of the diagnostic-instrumental approach protocol to thromboembolic disease.

A new method for study of the rectum using transvaginal ultrasound with water enema.

BACKGROUND: To propose a new method for the ultrasound study of the rectum. METHODS: Twenty-one healthy female patients, 58-72 years old, were examined. To achieve optimal filling and distention of the rectum, the examination was performed with the patient in the right lateral decubitus position. After placing the probe into the vagina, 1000-1500 mL of water warmed to 35 degrees C was introduced into the rectum through a cannula. After the rectum was completely full, the cannula was extracted. Images were obtained before and after rectum distention on the transverse plane by using a 5.0-MHz convex radial endocavitary probe. RESULTS: Using water eliminated air and fecal artifacts, so rectal wall layers were reliably demonstrated, with the rectal ampulla well distended. In addition, the rectum in whole circumferential extension and the perirectum fat were clearly visualized. CONCLUSION: This new method is useful for study of the rectum.

[Transvaginal echography in the study of the rectum. A new method with rectal distension with water]. / L'ecografia transvaginale nello studio del retto. Nuova metodica mediante distensione dell'ampolla rettale con acqua.

Transrectal sonography (TRUS) accurately assesses the depth of invasion in the staging of rectal carcinomas. However, the method is limited in the evaluation of upper rectal and highly stenotic rectal cancers. These conditions can be demonstrated in female patients by transvaginal sonography (TVUS) with a 5-MHz convex probe. Conventional TVUS becomes even more accurate when the rectum is distended with water. Twenty-one asymptomatic female patients were examined in a prospective study to assess the value of conventional versus water-distended TVUS. Water improves rectal depiction because it eliminates air and fecal artifacts. In our series, the rectum was demonstrated from anum to rectosigmoid junction in all cases. The whole rectal outline could also be demonstrated. Besides rectal lumen evaluation, the method allowed rectal wall layers and perirectal fat to be detailed. Subsequently, 14 female patients were examined--8 during the preoperative staging and 6 during the follow-up. In preoperative patients, the extent of stenosing rectal cancer and perirectal fat infiltration were assessed; in postoperative patients rectal recurrences were excluded. In conclusion, TVUS with rectal distension by means of water is a new diagnostic procedure which can markedly improve the US imaging of highly stenosing rectal cancers.

Rectal carcinoma: preoperative staging and detection of postoperative local recurrence with transrectal and transvaginal ultrasound.

Transrectal ultrasound (TRUS) was performed preoperatively in 35 patients with rectal carcinoma and the results were compared to histologic findings. In the same group, postoperative studies were performed in 22 patients; in women, transvaginal ultrasound (TVUS) was added to the transrectal study. According to Duke's classification modified by Astler-Coller, in relation to the "T" parameter, TRUS correctly staged 33 of 35 neoplasms (accuracy, 94.3%); one was overstaged and one was understaged. In detection of lymph node involvement, accuracy was 74% (sensitivity 69%, specificity 73.9%). Recurrent local tumors, histologically confirmed, developed in two of 22 postoperative patients who had undergone curative anterior resection. This study demonstrates that TRUS is an accurate method in preoperative staging of rectal carcinoma. In the prospective study, the role of follow-up TRUS and TVUS in detection of local recurrences is evaluated.

[Opportunistic infections in AIDS. The pulmonary manifestations]. / Infezioni opportunistiche nell'AIDS. Manifestazioni polmonari.

The initial and follow-up chest radiographs of 31 patients with the acquired immunodeficiency syndrome (AIDS) were reviewed to assess the spectrum and frequency of opportunistic pulmonary infections. In our series, the most common pulmonary infections seen on chest films were: Pneumocystis carinii pneumonia (PCP) (n = 17), PCP associated with Cytomegalovirus (CMV) (n = 2), PCP associated with Mycobacterium avium-intracellulare (MAI) (n = 1), Mycobacterium tuberculosis (n = 7), CMV (n = 2), MAI (n = 1) and Cryptococcus neoformans (n = 1). Diffuse or focal interstitial infiltrate is the most common finding in PCP; bilateral focal or multilobar interstitial infiltrates are also frequently observed: they are usually caused by PCP or by PCP associated with CMV. Infiltrating cavitating lesions and multiple interstitial well-defined nodules < 10 mm diameter were seen only in Mycobacterium tuberculosis infections. Normal chest findings and/or pleural effusions were uncommon; no case exhibited pulmonary cysts on initial radiographs. In this retrospective study we emphasize the high incidence of Mycobacterium tuberculosis infections; other pulmonary infections are emerging in AIDS. The X-ray patterns of pulmonary infections in AIDS must be known for a prompt and accurate diagnosis and to plan the appropriate treatment.

[Echography in the study of the neonatal hip: the diagnostic-therapeutic implications of type-IIa (borderline) findings]. / L'ecografia nello studio dell'anca neonatale: implicazioni diagnostico-terapeutiche dei reperti di tipo IIa (borderline).

Sonography (US) is a useful method in the early diagnosis of congenital hip dislocation; X-ray examination exhibits limitations due to high false-positive and false-negative rates. The advantages of US include: non-invasiveness, direct visualization of muscle and cartilage, dynamic demonstration of anatomical structures, and possible diagnosis in neonatal age. Therefore, US can be used as a screening or targeted diagnostic technique in selected newborns with clinical suspicion and/or risk factors. In this paper the authors report their experience in 1271 patients (721 females, 550 males), aged 1 day to 7 months, who were examined with US for the diagnosis of congenital hip dislocation. The newborns were divided into two groups at first examination: a) the screening group included 524 consecutive newborns (F = 266, M = 258) from S. Chiara Regional Hospital in Trento, and b) a selected group of 747 newborns (F = 455, M = 292) with clinical suspicion and/or risk factors, who had been selected in the Trento area. According to Graf's classification, the results of US in 2542 neonatal hips, were: 2346 (92.3%) normal hips, 171 (6.1%) type IIa hips, and 24 (1.6%) pathological hips. In the selected group (1494 hips) we observed: 1351 (90.4%) normal, 119 (8%) type IIa, and 24 (1.6%) pathological hips (IIb, IIc, D, III). In the screening group (1048 hips) we detected: 995 (95%) normal hips (Ia/Ib), 52 (4.9%) type IIa, and 1 (0.1%) pathological hips (D). Our experience suggests that US is a useful method in selected newborns with clinical suspicion of congenital hip dislocation and/or risk factors. US limitations consists in the dispersion of type IIa hips. Moreover, the need emerged for complete cooperation between pediatrician, radiologist, and orthopedist to optimize the cost/benefit ratio.

[Mega-poly-calicosis. Apropos of a case with prenatal and postnatal diagnosis]. / Mégapolycalicose. A propos d'un cas avec diagnostic anté-natal et postnatal.

We report the first published case of megapolycalicosis with prenatal ultrasound diagnosis. Pyeloureteral junction dysplasia was observed only after delivery. The etiopathogenesis of megapolycalicosis (MPC) and its hypothetical association with uretero-pelvic junction obstruction are discussed. Presence of polycalicosis, good glomerular filtration and absence of compensatory controlateral renal hypertrophy are determinant in the diagnosis.

[Sclerotherapy of varicocele. Efficacy of radiological, clinical and seminal treatment]. / Sclérose des varicocèles. Efficacité du traitement du point de vue radiologique, clinique et séminal.

Between december 1983 and april 1989, percutaneous retrograde sclerotherapy of varicocele was successfully performed on 364 patients. A 5% solution of sodium morrhuate and benzylic alcohol (Varicocid) was administered through a coaxial balloon catheter inserted into the spermatic vein. 10 of the patients had relapses after surgery. Long-term follow-up was available for 268 patients (73.6%). Three of them had incomplete relapses after sclerotherapy. In terms of spermatologic improvement, sclerotherapy appeared to be effective in the treatment of varicoceles. In our experience, sclerotherapy is a safe effective procedure to be preferred to surgery in the management of varicocele.

[Abdominal angina: percutaneous transluminal angioplasty of the superior mesenteric artery]. / Angina abdominalis: Transluminale perkutane Angioplastik der Arteria mesenterica superior.

Percutaneous transluminal angioplasty (PTA) of the superior mesenteric artery (SMA) was performed in a 65-year-old man with clinical and radiographic evidence of abdominal angina. The patient was relieved of abdominal pain immediately after the dilatation. At the angiographic follow-up (7 months later) the SMA was of normal caliber. At the last follow-up visit (14 months after intervention), the patient was still free of pain. PTA of SMA stenoses is an alternative to surgical revascularization, and can be repeated if symptoms recur.

[Hürthle cell tumor of the thyroid: which surgical approach?]. / Tumori a cellule di Hürthle della tiroide: quale tattica chirurgica?

Hürthle cell tumors are a very particular thyroid disease. Controversies exist about the most adequate treatment. Radical surgery is sometimes advocated also for benign lesions, due to their malignant potential, but conservative surgery is thought to be adequate in most cases. The Authors' experience consists of 8 Hürthle cell tumors: 7 adenomas and 1 carcinoma. The latter has been treated by total thyroidectomy and the patient died after 6 months. Adenomas have been always treated by conservative procedures and there is no recurrence at a 2-6 year follow-up.

[Varicocele: the effects of sclerotherapy on hemodynamics and spermatogenesis]. / Varicocele: effetti della scleroterapia sull'emodinamica e sulla spermatogenesi.

Between January 1984 and July 1988, percutaneous retrograde sclerotherapy of varicocele was successfully performed on 267 patients. A 5% solution of sodium morrhuate and benzylic alcohol (Varicocid) was administered through a coaxial balloon catheter inserted into the spermatic vein. Nine of the patients had relapses after surgery. Long-term follow up was available for 248 patients. Three of them had incomplete relapses after sclerotherapy. In terms of spermatologic improvement, sclerotherapy appeared to be effective in the treatment of varicoceles. In our experience, sclerotherapy is a safe and effective procedure to be preferred to surgery in the management of varicocele.

[Value of percutaneous sclerotherapy in the treatment of varicocele. Technic and results]. / L'intérêt de la sclérothérapie percutanée dans le traitement de la varicocèle. Technique et résultats.

Since December 1983, percutaneous transvenous retrograde sclerotherapy of the internal spermatic vein was performed successfully, without complications in 37 patients. The administration of the sclerosing agent through a coaxially balloon catheter specifically inserted into the spermatic vein caused therapeutic hardening. The effectiveness of the treatment was endorsed by subsequent checks by clinical and radiological examinations.