[Diagnostic imaging and therapeutic implications in lung infections in patients with HIV-1 infection]. / L'imaging diagnostico e le implicazioni terapeutiche nelle infezioni polmonari del paziente affetto da HIV1.

We studied retrospectively 132 episodes of infectious pneumonias in 89 patients examined from 1990 to 1995. Pneumocystis carinii was found to be the most common cause of pneumonia (33 patients). The other causes were: Streptococcus pneumoniae (15), Mycobacterium tuberculosis (14), Pseudomonas aeruginosa (8), Staphylococcus aureus (5), Cytomegalovirus (4), Haemophilus influentiae (4), Mycobacterium avium intracellulare (2), Klebsiella pneumoniae (2), E. coli (2), Serratia marcescens (1). No etiologic agent was found in 40 cases. We stress the need of a more frequent use of invasive diagnostic procedures in the study of focal lung consolidations because this radiologic sign is highly aspecific and may be caused by too many different pathogenic agents, needing different therapies-i.e., Streptococcus pneumoniae (15 cases), Pseudomonas aeruginosa (8), Staphylococcus aureus (5), Klebsiella pneumoniae (2), Escherichia coli (2), Pneumocystis carinii, Serratia marcescens and Haemophilus influentiae (1). Since there is an increase in mortality among patients treated with empiric antibiotic therapy, we stress the need of the routinary use of bronchoalveolar lavage in HIV+ patients with lung consolidation to perform specific therapy. Moreover, Pneumocystis carinii is by far the most frequent cause of diffuse interstitial infiltrates, and PCP has very suggestive clinical (dyspnea), radiologic (diffuse perihilar interstitial infiltrates; ground glass opacities; pneumatoceles) and laboratory (CD3+CD4 < 200/mcl; LDH > 600 UI/dl; PO2 < 70 mmHg) patterns, always related to the discovery of Pneumocystis carinii in escreatum. Thus, we decided to treat 15 patients with specific therapy for Pneumocystis carinii pneumonia with the above diagnostic algorithm, obtaining in all of them complete clinical and radiologic recovery. To conclude, in critical patients, invasive procedures should be performed only in the cases in which PCP is clinically improbable.

[The role of echotomography in sports traumatology of the lower extremity]. / Ruolo dell'ecotomografia nella traumatologia da sport dell'arto inferiore.

Sonography, which is commonly used in the evaluation of muscular traumas following exercise, quite often provides the radiologist with normal findings. One hundred and fifty-nine athletes were considered (170 US examinations), and the clinical diagnoses the patients had been referred for were compared with US findings: the pathologic condition was confirmed in 59% of the cases, while the extant 41% had normal findings. The highest percentage of positive findings was observed in the Achilles tendon region (75%), while the figure dropped to 38% in the thigh. In the latter location, muscular ruptures were confirmed in 69% of the cases, versus 17% in case of muscular distraction. As for the Achilles tendon, pathologic conditions both along the axis and in the insertion of the tendon were confirmed in 20% of the cases, but clinical accuracy was improved by US in 47% and 20% of the patients, respectively, and the diagnosis was changed in 10% and 20% of the cases, respectively. Therefore, clinical accuracy was demonstrated to depend on the pathologic condition as well as on the anatomical region involved.

[The optic pathways: a magnetic resonance study at 1.5 tesla. I. Anatomy]. / Le vie ottiche: studio mediante Risonanza Magnetica da 1,5 tesla. Prima parte: anatomia.

The authors retrospectively examined one hundred and twenty-nine patients who had undergone MR examination of the sellar, parasellar and orbital regions, to evaluate MR capabilities in demonstrating the optic pathways and their relationship to the most important anatomical structures nearby. T1-weighted images allowed a very good evaluation not only of the optic pathways as a whole, but also of the intracanalicular and intracranial segments of the optic nerve; the optic tracts and geniculate bodies were also clearly demonstrated. Optic radiations were clearly visible on both T1- and T2-weighted images. The orbital portion of the optic nerve could be evaluated with T1-weighted images, which showed its external profile. However, only multi-echo T2-weighted images allowed the nerve to be differentiated from perineural spaces, filled with cerebrospinal fluid, thus giving a true cisternographic effect.