Focal nodular hyperplasia of the liver: an emerging complication of hematopoietic SCT in children.

Hepatic focal nodular hyperplasia (FNH) is a nonmalignant condition rarely affecting children previously treated for cancer, especially those who received hematopoietic SCT (HSCT). Some aspects of its pathogenesis still remain unclear and a strong association with specific risk factors has not yet been identified. We report here a single institution's case series of 17 patients who underwent HSCT and were diagnosed with FNH, analyzing retrospectively their clinical features and the radiological appearance of their hepatic lesions. We aimed to compare the diagnostic accuracy of ultrasound (US) and magnetic resonance imaging (MRI) and to explore the role of transient elastography (FibroScan) to evaluate the degree of hepatic fibrosis in FNH patients. Our analysis showed an association of FNH with age at transplant ⩽12 years (hazard ratio (HR) 9.10); chronic GVHD (HR 2.99); hormone-replacement therapy (HR 4.02) and abdominal radiotherapy (HR 4.37). MRI proved to be a more accurate diagnostic tool compared with US. Nine out of 12 patients who underwent FibroScan showed hepatic fibrosis. Our study points out that FNH is an emerging complication of HSCT, which requires a lifelong surveillance to follow its course in cancer patients.

Imaging of primary sclerosing cholangitis: preliminary results by two new non-invasive techniques.

BACKGROUND: Magnetic resonance cholangiography is a new technique which has already gained a role in primary sclerosing cholangitis. Computerised tomographic cholangiography is another non-invasive technique which has been used in assessing abnormal biliary tree, but has never been applied to evaluating primary sclerosing cholangitis. AIMS: To evaluate the ability of both magnetic resonance cholangiography and computerised tomographic cholangiography to detect bile duct changes in primary sclerosing cholangitis. PATIENTS AND METHODS: Magnetic resonance cholangiography and computerised tomographic cholangiography were performed in 16 primary sclerosing cholangitis patients. The computerised tomographic cholangiography data set was transferred to a processing workstation to obtain tridimensional reconstructions. Magnetic resonance cholangiography and computerised tomographic cholangiography images were analysed blind by two radiologists to assess: primary sclerosing cholangitis involvement, quality of imaging and the radiologist's certainty in determining the presence and location of the disease. RESULTS: Mean imaging quality was significantly better with computerised tomographic cholangiography compared with magnetic resonance cholangiography. Primary sclerosing cholangitis was identified in 15 cases with computerised tomographic cholangiography and 10 with magnetic resonance cholangiography (P < 0.05). Sensitivity in diagnosing primary sclerosing cholangitis was 94% with computerised tomographic cholangiography versus 63% with magnetic resonance cholangiography. Intrahepatic location was found in 14 cases, definitely present in 10 cases with computerised tomographic cholangiography and five with magnetic resonance cholangiography. Extrahepatic location was found in 13 cases, definitely present in 11 cases with computerised tomographic cholangiography and four with magnetic resonance cholangiography (P < 0.05). Computerised tomographic cholangiography also offered dynamic information about biliary excretion. CONCLUSIONS: Computerised tomographic cholangiography enables more accurate detection and location of primary sclerosing cholangitis than magnetic resonance cholangiography. Since computerised tomographic cholangiography offers additional information about biliary excretion, it may be proposed as an integrative technique in the diagnosis and follow-up of patients with primary sclerosing cholangitis.

Rectal cancer: CT local staging with histopathologic correlation.

BACKGROUND: Many surgical options, eventually combined with neoadjuvant therapy, are available for the treatment of rectal cancer. Preoperative staging is essential to plan the correct treatment. Our aim was to evaluate the diagnostic accuracy of computed tomography (CT) in the local staging of rectal cancer. METHODS: Between February 1995 and May 2000, 105 patients (65 male, 40 female; mean age = 58, range = 36-88 years) after preoperative locoregional CT staging underwent rectal resection for rectal cancer. In all patients, radiologic T and N staging was verified with pathologic examination of excised specimens. Patients were examined after air insufflation of the ampulla, during intravenous contrast injection; analysis of the rectoanal region was performed with thin (3-5 mm) contiguous slices. For T staging, Tis-T2, T3, and T4 groups were considered. For N staging, two groups of patients were considered: in 52 patients, N+ stage was attributed to all visible lymph nodes; in the other 53 patients, only lymph nodes >5 mm were recorded as N+. RESULTS: Pathologic examination showed 61 T1-T2, 40 T3, and four T4 tumors; CT examination correctly identified 50 T1-T2 (81.9%), 33 T3 (82.5%), and three T4 (75%) lesions. With regard to N stage, pathologic examination in the first group (52 patients) showed only 11 cases of lymph node involvement. CT examination detected all 11 true-positive lymph nodes but overestimated 30 false-positive cases. In the second group (53 patients), pathology showed 26 cases of nodal involvement: CT examination identified 23 true-positive, 19 true-negative, eight false-positive, and three false-negative lymph nodes. CONCLUSION: CT correctly staged 86 (82%) of 105 lesions. Overestimation occurred in T2 patients (11 of 61, 18%) and underestimation in T3 patients (seven of 33, 21%), in accordance with other reports dealing with superior accuracy of endorectal ultrasonography in local staging of early disease. Conversely, the criterion we suggest for evaluating metastatic perirectal lymph nodes (diameter > 5 mm) provided 79.2% diagnostic accuracy, 88.5% sensitivity, and 86.5% negative predictive value. This can be useful in those patients in whom prompt surgery, soon after radiochemotherapy in the case of nodal involvement, may likely be curative. With further improvement with spiral CT in local staging and nodal involvement, a larger number of transanal curative resections can be predicted.

Defecographic measurements of rectal intussusception and prolapse in patients and in asymptomatic subjects.

OBJECTIVE: The aim of this study was to provide measurements for the defecographic diagnosis of rectal intussusception and rectal prolapse. MATERIALS AND METHODS: Four hundred thirty-seven consecutive patients with defecation and micturition disorders and gynecologic complaints were studied by means of defecography (120 patients), colpodefecography (17 patients), or cystocolpodefecography (300 patients). As a control group, 43 asymptomatic subjects underwent defecographic examination. RESULTS: Thirty-five patients were found to have rectal intussusception and 18, to have rectal prolapse. Anterior and posterior rectal wall folding thickness, intussuscipiens diameter, intussusceptum lumen diameter, and the ratio between the intussuscipiens diameter and the intussusceptum lumen diameter were measured in all patients. The findings were compared with those obtained in 13 of 43 asymptomatic subjects with rectal outline changes mimicking intussusception. Rectal folding thickness and the ratio between the intussuscipiens diameter and the intussusceptum lumen diameter were significantly greater in subjects with rectal intussusception and rectal prolapse than in asymptomatic subjects with rectal mucosa folding. CONCLUSION: Our findings suggest that dynamic evacuation radiology contributes to making a differential diagnosis between rectal intussusception and mucosal folds in the rectum.

Carbohydrate-deficient transferrin determination revisited with capillary electrophoresis: a new biochemical marker of chronic alcohol abuse.

To aid in the objective diagnosis of chronic alcohol abuse in both clinical and medico-legal environments, reliable biochemical markers are needed. In addition to the conventional indicators, which include y-glutamyl transferase, erythrocyte mean corpuscular volume, aspartate aminotransferase, and alanine aminotransferase, carbohydrate-deficient transferrin (CDT) has recently been introduced. According to a reliable body of literature, CDT is the most reliable marker of chronic excessive alcohol intake. CDT is the collective name for minor isoforms of human transferrin, and therefore highly selective and sensitive methods are required for its analysis in serum. Moreover, the need for precise quantification poses additional problems of accuracy and precision. For these purposes, capillary electrophoresis shows excellent potential in terms of quantitative accuracy, precision, speed, automation, economy, and simplicity of operation. The simple, optimized capillary zone electrophoretic analysis of CDT in human serum is discussed in this paper and is compared to the traditional analytical method based on microcolumn ion exchange chromatography followed by immunoassay.

[Use of the Palmaz-Schatz stent in the acute phase of myocardial infarction in a patient with cardiogenic shock]. / Emprego do stent de Palmaz-Schatz na fase aguda do infarto do miocárdio em paciente com choque cardiogênico.

A 56-year-old female patient underwent myocardial revascularization with three saphenous bypass grafts. One month after surgery she had an acute myocardial infarction with cardiogenic shock and was treated with a Palmaz-Schatz stent implantation in the left main coronary artery (that was occluded) and a PTCA of the graft to the right coronary artery. The in hospital outcome was uneventful and angiographic study after six months showed no restenosis and important improvement in the left ventricular function.

[Echocardiographic relation criteria. A new selection method for mitral valvotomy with balloon catheter]. / Critério de relação ecocardiográfica. Um novo método para a indicação da valvotomia mitral com cateter-balão.

PURPOSE: To find out new subjects that could be useful to select patients between 9 and 12 points, according to Block's Criteria, to mitral balloon valvotomy. METHODS: One hundred and forty patients underwent mitral balloon valvotomy. Among them, 29 (21%) had between 9 and 12 points. These patients were divided into two groups: group A-patients with mitral valve area > or = 1.5cm2, immediately after balloon valvotomy and in the follow-up period; group B-patients with mitral valve area < 1.5cm2 immediately after or during the follow-up period, patients with severe mitral regurgitation after the procedure and patients who died in the follow-up period. All patients were analyzed by echocardiographic relation criteria (ERC): calcification + subvalvar disease/thickness + mobility. Each one was quantified from 1 to 4 points according to the degree of valvular disease. RESULTS: Group A was composed of 17 (51%) and group B 12 (41%) patients. The variables age, sex, previous mitral commissurotomy and atrial fibrillation did not show difference between groups. In group A mitral valve area (cm2) increased from 1.15 +/- 0.25 to 1.97 +/- 0.26 (p < 0.00001) keeping stable during the follow-up period. In group B percutaneous mitral balloon valvotomy resulted in an increase from 1.26 +/- 0.19 to 1.77 +/- 0.16 (p < 0.00001), however, there was an important decrease in the follow-up period to 1.34 +/- 0.15 (p < 0.00001). The ERC showed that all group A patients had a relation < 1. However, in group B, 10 patients (83%), the relation was > or = 1, and in only 2 patients (17%) was < 1 (p < 0.00001). CONCLUSION: The group of patients between 9 and 12 points in the Block's criteria is heterogenic, therefore, each case might be evaluated individually and the echocardiographic relation criteria should be used in order to select these patients to the procedure.

[The laryngeal status of the workers of 2 plants producing primary aluminum]. / Situazione laringea nei lavoratori di due impianti di produzione di alluminio primario.

The paper reports the results of an indirect laryngoscopic investigation performed in the two-year period 1988-89 on 347 workers in two different primary aluminium production plants. A model is proposed for classification of the laryngeal state into 4 classes of increasing severity of clinical findings. An analysis was made of the statistical relationship between laryngeal class, occupational exposure, cigarette smoking, alcohol consumption, and age. A multivariate analysis of the data was performed using the logistic regression test. Smoking and age were shown to have a statistically significant influence (p < 0.0001 and p < 0.005 respectively) on the development of chronic laryngitis. No statistically significant difference was observed for alcohol consumption and in the comparison between workers and controls.

Echocardiographic long-term evaluation of percutaneous balloon mitral valvotomy.

Percutaneous balloon mitral valvotomy (BMV) is an alternative therapeutic method for patients with mitral stenosis. We studied 62 patients (56 females, mean age 36.4 years) who underwent balloon mitral valvotomy. Five patients were pregnant and in New York Heart Association Functional Class IV. Doppler echocardiographic studies were performed prior to the procedure, and at 7 days, 6 months, 12 months, and 24 months after the procedure. We studied the following parameters: echo-score by the sum of valvular mobility, thickening, and calcification, and subvalvular disease, graded from 1 to 4; and mitral valve area (MVA) and mitral pressure gradient (MPG) by Doppler echocardiography. The patients were separated into two groups: group I with an echo-score less than or equal to 8 (40 patients), and group II with an echo-score greater than or equal to 9 (22 patients). Mitral valve area and MPG were compared with hemodynamics through the correlation coefficient and linear regression. Comparison between groups I and II was performed using the unpaired Student's t-test. Follow-up of MVA and MPG was analyzed by analysis of variance. The Student's t-test did not show any significant difference between MVA and MPG before balloon mitral valvotomy. There was significant decrease of MVA in group II (P less than 0.01) in the last three studies. There was significant increase in MPG in group II (P less than 0.01) in every postvalvotomy study. The analysis of variance of group I showed statistical increase of the MVA, and significant decrease of the MPG after BMV. The analysis of variance of group II showed significant increase in MVA and significant decrease in MPG between the pre- and the first postvalvotomy study. There was significant decrease (P less than 0.01) in MVA, and increase in MPG in the three postvalvotomy studies. Complications included mitral regurgitation, residual interatrial communication, pericardial effusion due to an atrial wall perforation, and peripheral embolization. Atrial fibrillation did not significantly alter the results of BMV. Results were considered positive when MVA was greater than 1.5 cm 2 and area increase was greater than 25%. Patients with an echo-score less than or equal to 8 (group I) benefit from BMV, with a positive predictive value greater than 78%. In pregnant patients the symptomatology was alleviated by BMV, without any signs of fetal compromise.

[Mitral valvuloplasty with balloon catheterization in pregnant patients. Report of 3 cases]. / Valvoplastia mitral por cateter balão em pacientes grávidas. Relato de três casos.

The authors report on three pregnant patients with mitral stenosis with heart failure in functional class IV (NYHA) unresponsive to clinical treatment. They were submitted to mitral valvuloplasty, with significant clinical improvement, and were, hence, asymptomatic. Despite the small number of cases, it may be concluded that the procedure is simple and safe, which can be attested by the successful results.