[Amyloid osteoarthropathy in dialyzed patients: integrated imaging]. / Osteoartropatia da amiloide nei pazienti dializzati: imaging integrato.

We studied with US both the knees of 32 long-term dialysis patients (mean dialysis age: 69.7 months), 7 of whom exhibited palpable joint swelling. In 29/32 patients, US scans were combined with knee X-ray films, patellar views included. In one case, opaque arthrography was performed too. US demonstrated the presence of fluid collections within both joint space and synovial cavities in 19/32 patients (59%). Their content was transonic or mildly hypoechoic. X-ray films were positive for amyloid bone involvement in 19/29 cases (66%), with evidence of intra-osseous cysts and cortical erosions. There was a good general agreement between the results obtained with the two techniques: therefore, in some cases only one examination was positive. Needle aspiration of synovial fluid was performed in 18/32 patients (56%). The 2 cases of diffusely hypoechoic collections yielded very dense jelly material, that was highly positive for beta-2-microglobulin. US is proposed, combined with conventional X-ray films, as a simple and reliable method for the diagnosis of articular amyloidosis in dialysis patients and for the follow-up of this disease.

[AIDS in childhood]. / L'AIDS nell'età pediatrica.

HIV infection in infants is transmitted through the placenta. Antibodies reduce and annul in nearly 18 months: HIV + subjects older than 18 months are considered as infected and divided into two classes--i.e., P1: infected and P2: AIDS. The most interesting clinical and diagnostic imaging findings are reported relative to 209 babies who were born HIV + and followed-up with clinical and laboratory tests plus chest films, brain and abdomen US to assess the presence of changes and their evolution features. The following conclusions have been drawn: 1) in their early life, HIV + subjects are especially liable to the action of bacteria, viruses and protozoa: their respiratory system is easily affected with acute, recurring and/or chronic inflammations which are frequently associated with heart enlargement from dilatative cardiomyopathy. Bacterial inflammations are characterized by single or multiple opacities, with blurred and irregular patterns, which are frequently confluent in areas of inhomogeneous opacity. The diagnosis of virus and protozoa infections is more difficult because of their radiologic patterns--i.e., linear fan-like opacities, small shadow areas, enlarged hila. In some cases radiology demonstrates only or mostly lung hyperexpansion, with no opaque images, which however does not exclude the presence of severe and diffuse bronchioloalveolar and interstitial compromission with high-grade pulmonary insufficiency. The common association of cytomegalovirus and Pneumocystis carinii infections with slow-evolution changes and frequent recurrences appears on radiologic images as diffuse and blurred shadows and irregular cotton-like opacities. 2) Brain and abdomen US scans in the newborn show no particular changes, while in the following months both US and CT demonstrate hydrocephalic, atrophic and hemorrhagic changes. 3) In both early and late infancy, lung infections are mostly caused by pneumocystis and cytomegalovirus. Chronic interstitial lymphocyte pneumonia is a peculiar finding with punctiform images in the bases of lung and spreading craniocaudally with similar features to miliary tuberculosis. Different than in the adult, in our series of 209 infants no tubercular abnormalities were observed: in one patient only an active primary complex was demonstrated with broncholavage. Candida infections were observed in 3 patients in their late infancy. Hepatopancreatic and lymph node changes suggesting probably evolving inflammation were uncommon in our series; this condition must be followed-up and checked over time.