Conservative management in congenital severe bilateral hydronephrosis related to uretero-pelvic junction obstruction.

We report our experience in conservative management of patients with prenatal and neonatal diagnosis of severe bilateral ureteropelvic junction obstruction (UPJO), focusing on the actual predictors of renal function impairment or spontaneous resolution. Between 1996 and 2006, 20 patients with bilateral severe hydronephrosis related to UPJO were included in the study. Indications for surgery were an increased hydronephrosis, decreased renal function, onset of symptoms. Conservatively treated patients were followed up for 3 months to 10 years with renal ultrasound, DTPA diuretic, urine culture. At first renal scan, 22 out of 40 renal units had a poor, 10 an intermediary and 8 a good drainage. Pyeloplasty was required in 10 of the 40 kidneys, while 30 out of 40 kidneys were followed conservatively. At the end of follow up, sieric normalized creatinine and estimated glomerular filtration rate were normal in all patients. Our data showed that bilateral severe hydronephrosis related to UPJO can be safely managed in a similar manner of a unilateral case. A poor drainage could be considered a negative predictive factor in the feasibility of a conservative management.

The ipdC, hisC1 and hisC2 genes involved in indole-3-acetic production used as alternative phylogenetic markers in Azospirillum brasilense.

Plant growth-promoting bacteria of the genus Azospirillum are present in the rhizosphere and as endophytes of many crops. In this research we studied 40 Azospirillum strains isolated from different plants and geographic regions. They were first characterized by 16S rDNA restriction analysis, and their phylogenetic position was established by sequencing the genes 16S rDNA, ipdC, hisC1, and hisC2. The latter three genes are involved in the indole-3-pyruvic acid (IPyA) biosynthesis pathway of indole-3-acetic acid (IAA). Furthermore, the suitability of the 16S-23S rDNA intergenic spacer sequence (IGS) for the differentiation of closely related Azospirillum taxa and development of PCR protocols allows for specific detection of strains. The IGS-RFLP analysis enabled intraspecies differentiation, particularly of Azospirillum brasilense and Azospirillum lipoferum strains. Results demonstrated that the ipdC, hisC1, and hisC2 genes are highly conserved in all the assessed A. brasilense isolates, suggesting that these genes can be used as an alternative phylogenetic marker. In addition, IAA production determined by HPLC ranged from 0.17 to 98.2 µg mg(-1) protein. Southern hybridization with the A. brasilense ipdC gene probe did not show, a hybridization signal with A. lipoferum, Azospirillum amazonense, Azospirillum halopreferans and Azospirillum irakense genomic DNA. This suggests that these species produce IAA by other pathways. Because IAA is mainly synthesized via the IPyA pathway in A. brasilense strains, a species that is used worldwide in agriculture, the identification of ipdC, hisC1, and hisC2 genes by PCR may be suitable for selecting exploitable strains.

CT-MR integrated diagnostic imaging of the oral cavity: neoplastic disease.

The oral cavity is a complex anatomical region consisting of different anatomical sites and subsites. Cancer undoubtedly represents the most frequent and relevant disease of this region. Clinical examination is often the first approach to oral cavity tumours. Cross-sectional computed tomography (CT) and magnetic resonance imaging (MRI) play a key role in staging locoregional disease by demonstrating submucosal spread and involvement of deep layers; evaluation of specific pathways of spread to peculiar anatomical subsites is also fundamental information that can be obtained with these techniques. The purpose of this paper is to illustrate CT and MRI findings of anatomical subsites involved by tumours of the oral cavity.

High prevalence of coronary calcifications and increased risk for coronary heart disease in adults with growth hormone deficiency.

Assessment of coronary calcium deposits (CCD) by coronary computed tomography (CT) was recently introduced for evaluation of risk to develop events related to coronary heart disease (CHD). We investigated occurrence of CCD in 19 hypopituitary patients (patients), 34 healthy (H) subjects (H controls) and 36 patients with a similar rate of diabetes mellitus and hypertension (morbid, M), but without pituitary diseases (M controls). Patients were replaced with L-thyroxine, cortone acetate, sex hormones and/or desmopressin, but never with GH. Unenhanced coronary CT was performed by 16-row multislice scanner. Framingham score (FS) was calculated and CCD were measured by Agatston score (AS) in all subjects. AS>10 indicates increased CHD risk. CCD and AS >10 were detected in 50% and 33% of patients, respectively. Prevalence of CCD and mean AS were higher in patients than in H and M controls. In patients, AS was negatively dependent on IGF-I levels (p<0.01) and IGF-I SD (p<0.05), and AS >10 was associated with occurrence of hypertension (p<0.02) and hyperinsulinism (p<0.05). Men and women showed the same prevalence of AS >10 (25 vs 31%). FS and AS correlated significantly (rs=0.33, p<0.001), but CCD were detected also in 3/11 patients with low FS. In conclusion, 58% of patients were at CHD risk on the basis of increased FS and/or AS, above all if they were hypertensive and/or showed hyperinsulinism. CCD were detected also in patients with low FS. CHD risk is higher in women. Risk of CCD is increased in patients with low IGF-I levels.

Head and neck radiology: role of multidetector computed tomography in the evaluation of the tympanic canaliculus.

PURPOSE: This study was undertaken to evaluate the potential of multidetector computed tomography (MDCT) for multiplanar visualisation of the tympanic canaliculus both in healthy individuals and in patients affected by chronic inflammatory disease of the middle ear. MATERIALS AND METHODS: A preliminary study was performed on three dried skulls by placing a metal landmark inside the tympanic canal lumen with a view to optimising depiction by multiplanar CT. Subsequently, 50 patients were enrolled in a prospective study. Three of the 100 petrous pyramids studied were excluded owing to the presence of jugulotympanic glomus tumour with severe bone changes. RESULTS: The entire course of the tympanic canaliculus was identified in 80/97 petrous pyramids (82.4%), 57 of which were normal (75.4% detection rate) and 40 pathological (90% detection rate). To assess the tympanic canaliculus in the pathological petrous pyramids and evaluate its possible role in the disease process, some qualitative criteria were introduced: canal enlargement, loss of margin sharpness, focal erosion of canal margins and presence of pathological tissue. CONCLUSIONS: MDCT represents the only technique allowing evaluation of the tympanic canal in vivo and with multiplanar images in a large number of cases (82.4%).

Computed tomography coronary angiography in asymptomatic patients.

PURPOSE: This study assessed the accuracy of computed tomography coronary angiography (CT-CA) for detecting significant coronary artery disease (CAD; ≥50% lumen reduction) in intermediate/high-risk asymptomatic patients. MATERIALS AND METHODS: A total of 183 consecutive asymptomatic individuals (92 men; mean age 54±11 years) with more than one major risk factor (obesity, hypertension, diabetes, hypercholesterolaemia, family history, smoking) and an inconclusive or nonfeasible noninvasive stress test result (stress electrocardiography, stress echocardiography, nuclear stress scintigraphy) underwent CT-CA in an outpatient setting. All patients underwent conventional coronary angiography (CAG) within 4 weeks. Data from CT-CA were compared with CAG regarding the presence of significant CAD (≥50% lumen reduction). RESULTS: Mean calcium score was 177±432, mean heart rate during the CT-CA scan was 58±8 bpm and the prevalence (per-patient) of obstructive CAD was 19%. CT-CA showed single-vessel CAD in 9% of patients, two-vessel CAD in 9% and three-vessel CAD in 0%. Per-patient sensitivity, specificity, positive predictive value and negative predictive value of CT-CA were 100% (90-100), 98% (96-99), 97% (85-99), 100% (97-100), respectively. Positive and negative likelihood ratios were 151 and 0, respectively. CONCLUSIONS: CT-CA is an excellent noninvasive imaging modality for excluding significant CAD in intermediate/ high-risk asymptomatic patients with inconclusive or nonfeasible noninvasive stress test.

Role of virtual colonoscopy following incomplete optical colonoscopy: our experience.

AIM: To evaluate the role of Computed Tomography Colonography (CTC) in patients who failed an Optical Colonoscopy (OC). PATIENTS AND METHODS: Sixtyeight patients (48 female, 20 male; mean age 60,4 years) with a previous incomplete OC underwent CTC. RESULTS: A complete CTC examination was achieved in all 68 patients. We classified the detected polyps in relation to the diameter in small (<5mm), medium (from 5 to 10mm) and large (>10mm). In 19 patients (27,9%) any pathological finding was observed. In 11 patients (16,2%) one or more polyps not detected with the previous OC have been found.Only in one case the number of detected polyps corresponded to the OC findings. In 18 (26,4%) patients a diverticular disease was observed, and in 15 of them it was diagnosed by the previous OC (26,5%). In 8 patients (11,8%) the diverticular disease was associated to the presence of polyps. In 12 patients (17,6%) colonic stenosis or masses have been observed. CONCLUSIONS: CTC was performed in all patients with a previous incomplete OC, obtaining a complete and accurate visualization of the colon whithout any patient's discomfort.

Large epidural hematoma associated with ipsilateral retrobulbar hematoma. Case report.

A case of large fronto-temporo-parietal epidural hematoma associated with ipsilateral retrobulbar hematoma is reported. A 24-year-old man soon after a head injury due to a traffic accident became comatose with anisocoria and hemiplegia and developed exophthalmos, conjuctival chemosis, downward and lateral displacement of the eyeball. CT scan of the brain and the orbit showed the large epidural clot communicating with an ipsilateral retrobulbar hematoma through a sphenoid bone fracture. The patient underwent emergency surgery. Postoperatively, he improved and was discharged in good conditions. On follow-up one month later he was symptoms free. The available literature is reviewed: our case seems to be the fifth reported.

Role of coronal oblique reconstruction as a complement to CT study of the temporal bone: normal anatomy.

PURPOSE: The purpose of this study was to demonstrate the usefulness of coronal oblique multiplanar reconstruction computed tomography (MPR CT) reformation parallel to the basal turn of the cochlea in the evaluation of the retrotympanum and hypotympanum to complete the standard CT examination of the temporal bone obtained with axial and coronal images. MATERIALS AND METHODS: We studied 30 patients aged 18-79 years for a total of 60 normal petrous pyramids. All examinations were performed on a multislice CT (MSCT) scanner (Sensation 16, Siemens, Erlangen, Germany) with axial volumetric acquisition and completed with reformations of coronal and coronal-oblique images. MSCT scan parameters for axial acquisition were set as follows: 0.75-mm scan collimation, FOV 300 mm, 170 mAs. Axial images were reconstructed at 0.7-mm thickness and with a reconstruction increment of 0.5 mm using a high-resolution bone algorithm. RESULTS: Coronal oblique MPR CT reformations provided additional information with respect to standard CT images in all cases. In particular, they enabled measurement of the craniocaudal and laterolateral diameters of the sinus tympani. In all cases, there was optimal visualisation of the ponticulus and subiculum. Analysis of the pyramidal eminence was improved thanks to its visualisation in profile. Moreover, we obtained an optimal representation of the hypotympanum, which was always exhaustively explored with only one reconstruction. Finally, in all cases, it was possible to identify the facial nerve canal and main vascular structures and to measure the distance between these and the sinus tympani, pyramidal eminence and hypotympanum. The coronal oblique CT reformation was of no advantage in the evaluation of the fossa of the oval window and the niche of the round window. CONCLUSIONS: Coronal oblique MPR CT reformation should not be considered an alternative to the standard CT examination, but it can represent a valid integration to provide additional information on particularly crucial districts characterised by frequent involvement of inflammatory and/or expansile disease and because of their difficult endoscopic approach. Moreover, it can represent a meaningful aid to optimise surgical planning thanks to its different perspectives of observation.

[Significance of the circumferential involvement of the superior horn tip of the thyroid cartilage in pharyngo-laryngeal cancer]. / Significato dell'interessamento circonferenziale dell'apice del corno superiore della cartilagine tiroidea nel cancro faringo-laringeo.

UNLABELLED: The term "laryngopharyngeal carcinoma" indicates an advanced tumor involving both the supraglottic larynx and the pharynx in which the lesion origin may be difficult to assess. In 1981, Larsson et al. reported on the CT signs useful to distinguish the laryngeal/hypopharyngeal origin of advanced laryngopharyngeal carcinoma. We describe a new CT sign which may serve this purpose, namely the involvement of the thyroid cartilage superior horn tip. The thyroid cartilage superior horn, in fact, is involved early in the lesions originating in the pyriform sinus because of its close anatomic relationship with the posterolateral wall of the hypopharynx. MATERIALS AND METHODS. To assess the significance and specificity of this sign, we examined 15 patients with advanced laryngopharyngeal carcinoma with clinical, endoscopic and surgical evidence suggestive of tumors originating in the pyriform sinus. All CT examinations were performed with contiguous 4 mm slices before and after i.v. administration of iodinated contrast agents. Eighteen patients with surgically confirmed advanced supraglottic carcinoma were also examined. RESULTS: The thyroid cartilage superior horn tip was involved only in 3/18 supraglottic carcinoma patients; transcommissural infiltration of the larynx, involving both pyriform sinuses, was found in 2 of these cases and extensive invasion of the whole thyroid cartilage and of the cricoid ring in 1 case. CONCLUSIONS: The thyroid cartilage superior horn tip is a reliable sign of the pyriform sinus origin of advanced laryngopharyngeal cancer which is both sensitive (100%) and specific (83%). Moreover, this sign could play a major role because it represents, in most cases, the only and earliest sign of cartilage involvement. Finally, the encasement of the thyroid cartilage superior horn tip by abnormal tissue indicates tumor spread beyond the posterior pharyngeal wall. Therefore, these data can be very important for its early detection and useful for subsequent surgical planning.

Hepatobronchial fistula due to transphrenic migration of hepatic echinococcosis: MR demonstration.

We present an uncommon case of hepatic hydatidosis, complicated by transphrenic migration of the cyst, in which the use of magnetic resonance performed with ultrafast, breath-hold, heavily T2-weighted sequences (HASTE) demonstrated a bronchial fistula.

[Computerized tomography in the evaluation of anatomic variations of the ostiomeatal complex]. / La tomografia computerizzata nella valutazione delle varianti anatomiche del complesso ostiomeatale.

This work was aimed at showing the main anatomical variations in the ostiomeatal complex which are usually depicted by CT. A hundred and thirty CT exams including 59 normal cases (45.4%) and 71 cases of chronic sinus disease (54.6%) were reviewed. The following anatomical variations were considered: concha bullosa, middle turbinate, septum, uncinate process and bulla changes, Haller cells and agger nasi cells. Anatomical variations were demonstrated in 69 patients--31 normal subjects and 38 patients with chronic sinusitis. The incidence of every anatomical variation was investigated and the results were compared with literature data. Excluding agger nasi cells, which were seen in nearly all patients, the most common variations were concha bullosa and septal spur and deviations, while the least common variations were those in the middle turbinate and uncinate process.

Gallbladder duplication: MR cholangiography demonstration.

Gallbladder duplication is a rare anatomic malformation. We present a case of gallbladder duplication in a patient who underwent laparoscopic cholecystectomy in which breath-hold magnetic resonance cholangiography showed the biliary anomaly, allowing a correct preoperative differentiation of the specific type of duplication.

Cytokinin production by plant growth promoting rhizobacteria and selected mutants.

One of the proposed mechanisms by which rhizobacteria enhance plant growth is through the production of plant growth regulators. Five plant growth promoting rhizobacterial (PGPR) strains produced the cytokinin dihydrozeatin riboside (DHZR) in pure culture. Cytokinin production by Pseudomonas fluorescens G20-18, a rifampicin-resistant mutant (RIF), and two TnphoA-derived mutants (CNT1, CNT2), with reduced capacity to synthesize cytokinins, was further characterized in pure culture using immunoassay and thin layer chromatography. G20-18 produced higher amounts of three cytokinins, isopentenyl adenosine (IPA), trans-zeatin ribose (ZR), and DHZR than the three mutants during stationary phase. IPA was the major metabolite produced, but the proportion of ZR and DHZR accumulated by CNT1 and CNT2 increased with time. No differences were observed between strain G20-18 and the mutants in the amounts of indole acetic acid synthesized, nor were gibberellins detected in supernatants of any of the strains. Addition of 10(-5) M adenine increased cytokinin production in 96- and 168-h cultures of strain G20-18 by approximately 67%. G20-18 and the mutants CNT1 and CNT2 may be useful for determination of the role of cytokinin production in plant growth promotion by PGPR.