[A case of reflex sympathetic dystrophy in childhood]. / Un caso di distrofia simpatica riflessa dell'infanzia.

Reflex sympathetic dystrophy, a well-described clinical entity that is frequently encountered in adults, is uncommonly reported in children. We report a case of reflex sympathetic dystrophy in a little girl aging 8 years. The main symptom was the acute pain referred to the right lower extremity. We underline once more the difficult of diagnosis and the contribution of 3-phase bone scan.

[Diagnostic reliability of ultrasonography in the preoperative staging of the N parameter in head and neck neoplasms]. / Attendibilità diagnostica dell'ecotomografia nella stadiazione preoperatoria del parametro N nelle neoplasie del capo-collo.

The demonstration of metastatic involvement of neck nodes is a crucial step in the staging of patients with head and neck tumors. Diagnostic accuracy, sensitivity, and specificity of US in the detection of lymph node metastases were evaluated in 48 patients with this type of malignancy. The patients subsequently underwent surgical node dissection. Comparison of US, clinical and histological data demonstrated US to have 93.7% diagnostic accuracy, 100% sensitivity, and 84% specificity--the corresponding clinical values being 81%, 79%, and 84%, respectively. Among several US parameters, a substantial role in differentiating metastatic from tumor-free lymph nodes was played by the evaluation of roundness index (RI), and by the demonstration of an intranodal hyperechoic stria: RI value was always higher than 2 in tumor-free nodes and the hyperechoic stria was always absent in metastatic nodes. US approach never failed to demonstrate metastatic nodes while clinics missed them in 6 patients. Thus, US appears the most valuable diagnostic tool for staging head and neck tumors; its diagnostic accuracy can be increased by the combination with US-guided aspiration biopsy.

[SPECT with 99m-TC HM PAO in the study of classical hemicrania]. / La SPET con 99mTc-HM PAO nello studio dell'emicrania classica.

Five patients presenting with migraine attacks underwent Electroencephalography (EEC), Computed Tomography (CT) and Single Photon Emission Tomography (SPECT) with 99mTc-HM PAO. EEG and SPECT were subsequently repeated in the intercritical period. We observed that: two patients only showed non-specific abnormalities in EEG; scans were normal in all patients; all subjects exhibited diffuse cortical hypoperfusion. A strong correlation was always found between clinical presentation and hemispheric impairment. One patient exhibited asymmetrical perfusion between cerebellum hemispheres; intercritical SPECT showed homogeneous distribution of the radio-tracer in four patients. In the last one minimal residual hypoperfusion was observed, although less marked than in the acute phase. Therefore SPECT with 99mTc-HM PAO can be reasonably employed as the examination of choice when a migraine attack is clinically suspected, because of its reproducibility and reliability. It can be easily performed in every nuclear medical center supplied with modern tomographic gamma-cameras.

Parotid metastasis of Merkel cell carcinoma in a young patient with ectodermal dysplasia. Diagnosis by fine needle aspiration cytology and immunocytochemistry.

Fine needle aspiration (FNA) biopsy was performed on an intraparotid lymph node metastasis of a Merkel cell carcinoma of the eyelid in a 15-year-old girl with antecedent ectodermal dysplasia syndrome. The cytologic appearance of the aspirate and the results of immunocytochemical typing of intermediate filaments on the FNA smears provided a definitive diagnosis. The Romanowsky stain provided an excellent delineation of paranuclear intracytoplasmic "buttons," which appeared to contain both cytokeratin and neurofilaments by immunocytochemical studies. These findings confirm previous data emphasizing the role of light microscopic observations, supplemented by proper immunocytochemical investigations, in the differential diagnosis of metastatic Merkel cell carcinoma in fine needle aspirates.

[Ultrasonography in the preoperative staging of carcinoma of the breast]. / L'ecotomografia nella stadiazione preoperatoria del carcinoma mammario.

Data relative to 51 patients operated for breast carcinoma were retrospectively reviewed. All patients had undergone US and mammographic evaluation of max diameter of the neoplastic nodule. The above data were correlated with pathologic measurements of the surgical specimens. US-pathologic correlation coefficient was extremely high (r = 0.94). US proved especially helpful in those cases where mammography had failed to visualize the mass-namely in patients with dense breasts. Nearly all evaluated carcinomas had a typical US pattern: a hypoechoic lesion with irregular outline. US is recommended in evaluating tumor response to nonsurgical conservative treatment.

[A comparative evaluation of iodine-131 OIH and technetium-99m MAG3 in the study of renal function]. / Valutazione comparata di Iodio-131 OIH e Tecnezio-99m MAG3 nello studio della funzionalità renale.

A new renal imaging agent, 99mTc mercaptoacetyltriglycine (MAG3), has been recently proposed in the nuclear medicine evaluation of renal function. Just like 131 orthoiodohippurate (OIH), 99mTc MAG3 is removed mainly by the renal tubules. An heterogeneous group of 39 patients underwent a radioisotopic study with the simultaneous injection of OIH (131I) and 99mTc MAG3. Image quality was found to be better with 99mTc MAG3 than with OIH (131I), because the former always allowed renal regions of interest (ROI) to be clearly demonstrated, even in case of severe renal impairment. A quantitative analysis was also carried out: effective renal plasma flow (ERPF) values were compared with renographic peak times evaluated by using both radiotracers. Our results demonstrate a firm correlation to exist between the informative content yielded by 99mTc MAG3 and by OIH (131I). Absolute ERPF value was higher with MAG3, but the correlation index (r = 0.98) allowed a simple correction factor to be introduced. In conclusion, MAG3 appears to be a good alternative to OIH.

[Equilibrium radioisotope angiocardioscintigraphy in noninvasive diagnosis of chronic respiratory insufficiency]. / L'angiocardioscintigrafia radio-isotopica all'equilibrio nella diagnostica non invasiva dell'insufficienza respiratoria cronica.

The role and utility of equilibrium radionuclide angiocardiography was estimated in non-invasive diagnosis of patients with Chronic Obstructive Pulmonary Disease (COPD). In 26 healthy subjects the average value of Right Ventricular Ejection Fraction (RVEF) was 54.8 +/- 7.2, versus 40.89 +/- 7.85 in 37 patients with COPD. Right heart catheterization was performed on 9 patients with COPD, randomly chosen, to analyze the correlation between RVEF values and average Pulmonary Artery Pressure (PAP) values: the correlation index was significantly high (r = 0.80). Moreover, an important agreement was observed between RVEF and PaCO2 values (r = 0.77).

[Right atrial myxoma: echocardiographic diagnosis and review of the literature. Description of a clinical case]. / Mixoma atriale destro: diagnosi ecocardiografica e revisione della letteratura. Descrizione di un caso clinico.

Two-dimensional echocardiography is the method of first choice for diagnosing right atrial myxoma. A case of right atrial myxoma, documented by two-dimensional echocardiography, is here presented. Two-dimensional echocardiography allows accurate assessment of, tumor size, site of attachment, mobility and consistency. This non-invasive technique has replaced angiocardiography in the routine preoperative evaluation of these cases. The myxomatous nature of the mass was confirmed at surgery.

[Analysis of diastolic heart function. Principles and considerations on the use of 2 harmonics]. / Analisi della funzione cardiaca diastolica. Principi e considerazioni sull'uso di due armoniche.

In this study the authors have briefly exposed the mathematical bases about the application of the Fourier transform in cardiac radioisotopic examinations. It has pointed out the usefulness of two harmonics for clinical applications.