[Echotomography and hyperechoic angiomas of the liver. The structural aspects in 297 cases]. / Ecotomografia e angiomi iperecogeni del fegato. Aspetti strutturali in 297 casi.

Two-hundred-seventy-nine hyperechoic liver hemangiomas were studied with sonography (US) in order to define their structural patterns and the incidence of the different signs that could be used for diagnostic purpose. For each hemangioma the following parameters were considered: hypoechoic areas inside the mass, posterior acoustic enhancement, hypoechoic halo surrounding the lesion, posterior attenuation, and calcifications. Hemangiomas were equally frequent in both sexes (1:1.1), and many patients presented with multiple lesions (44.7%). Hypoechoic areas were present in 70% of the hemangiomas, and acoustic enhancement in 29%. Other signs had a lower incidence: hypoechoic halo 2.86%, posterior attenuation 2.15%, and calcifications 1.1%. The authors believe that, in non-neoplastic patients, a hyperechoic hepatic lesion presenting with hypoechoic areas and acoustic enhancement, with no surrounding hypoechoic halo, can be confidently diagnosed as a hemangioma by US alone.

[Importance of biological findings in the ultrasonic diagnosis of neoplastic biliary obstructions]. / Importanza dei rilievi biologici nella diagnosi ecografica delle ostruzioni biliari neoplastiche.

The authors' purpose is to demonstrate the possibility of improving US reliability in the diagnosis of neoplastic obstructions of the bile ducts, basing their study on the hematic alkaline phosphatase level (AP), which is an earlier sign of obstruction than high bilirubin values. All 368 patients observed had AP levels above the threshold of 270 IU/l. The 34 patients with neoplastic obstruction (including 13 without jaundice) had more than twice the normal level of AP, and presented with at least one dilated bile duct in the biliary tree. Coronal scans of the main bile duct are fundamental in the diagnosis of the level of obstruction. It seems thus possible to affirm that US diagnosis of the biliary obstruction, together with high AP values (more than twice the normal), provides with reliable information as to the neoplastic nature of the biliary obstruction, even if jaundice is not present.

Prevalence of glomerular hyperfiltration and nephromegaly in normo- and microalbuminuric type 2 diabetic patients.

Glomerular hyperfiltration, correlated with nephromegaly, is a frequent finding in type 1 (insulin-dependent) diabetes. In type 2 (non-insulin-dependent) diabetes, very few studies have been performed, and the results have been inconclusive. Glomerular filtration rate (GFR) and kidney volume, using 99mTc-DTPA scintigraphy and ultrasonography, respectively, were evaluated in 58 control subjects and 163 type 2 diabetic patients; 79 of whom were normoalbuminuric and 84 microalbuminuric. In the two groups of patients, these parameters did not differ significantly from those of controls, even when hypertensive subjects were excluded. Glomerular hyperfiltration was observed in 10 cases; all were normotensive (9.8%), of whom 7 were normoalbuminuric and 3 microalbuminuric. Nephromegaly was observed in 3 other normotensive microalbuminuric diabetic patients. Hypertensive subjects showed a lower GFR than normotensive patients and control subjects. Multivariate analysis showed a negative correlation between glomerular filtrate and systolic blood pressure (BP) in the overall population of patients and in normo- and microalbuminuric patients taken separately. It is concluded that the relationship between these variables forms a continuum in our type 2 diabetic patients; it may also be important in determining the low prevalence of hyperfiltration and nephromegaly found in our patients, who had BP levels higher than those of controls.

[Multi-institution, multidisciplinary radiology and endoscopy trial of the diagnostic accuracy of the double contrast examination of the stomach surface]. / Trial policentrico multidisciplinare radiologia-endoscopia sul rendimento diagnostico dell'esame a doppio contrasto di superficie dello stomaco.

In 12 X-ray and gastroenterology departments 1570 patients, clinically suspected to have a gastric pathology, have been examined by double contrast (surface) examination of the stomach followed by gastroscopy. Diagnostic accuracy was 93% in respect of endoscopic data, assumed correct by hypothesis. On the basis of a cost and benefit evaluation, made according to the well known criteria, a wider routine use of the double contrast technique is proposed.