[Renovascular hypertension: possibilities of echo-color Doppler]. / L'ipertensione reno-vascolare: le possibilità dell'eco-color Doppler.

The evaluation of blood flow at the level of renal arteries by echo-Doppler may be useful in detecting a stenosis in patients affected by arterial hypertension. We studied 33 subjects with arterial hypertension using the most suitable scansions to visualize renal arteries. The measured parameters (R.I. and Vmax) resulted to be higher than normal range in 7 and 1 patients respectively. Then these patients underwent renal scintigraphy and arteriography; in 3 of them the presence of a stenosis of a renal artery was confirmed. Therefore the echo-Doppler study of renal arteries, even if has some shortcomings due to technic troubles, revealed to be a useful tool in the screening of hypertensive patients to support the other tools already used to this aim.

[Ureteral jet during medical treatment of benign prostatic hypertrophy]. / Il "jet" ureterale in corso di trattamento medico dell'ipertrofia prostatica benigna.

By Color-Doppler ultrasound it's possible to visualize urine flow from ureter into the bladder. Aim of the study was to image these ureteral jets in patients with benign prostatic hyperplasia (BPH) before and after therapy. Seven patients were studied, whose age ranged from 52 to 69 years; they were not affected by methabolic, hepatic, renal diseases and by prostate inflammation. A duplex scanner (Toshiba SSA 270 A) with a convex probe of 3.5 MHz was used. A transabdominal ultrasound study was performed, measuring prostatic volume and imaging ureteral jet before and along a treatment (at four months intervals) with Finasteride 5 mg/die (Finastid, Neopharmed) and at the end of treatment. We found that the mean velocity of jets in patient affected by was higher than in healthy subjects (80 cm/sec vs 60 cm/sec) bur during treatment it decreased along with symptom improvements and decreasing volume at US. We concluded that analysis of ureteral jets with Color-Doppler P.W. may add useful informations to real-time us in the study of patients affected by BPH undergoing treatment with Finasteride.

[Role of color Doppler echography in the diagnosis of obstructive uropathy]. / Ruolo dell'ecocolor Doppler nella diagnostica delle uropatie ostruttive.

Intrarenal Doppler US was performed in 20 patients with suspected renal obstruction and standard sonographic appearance of collecting-system dilatation. In 15 patients with true renal obstruction the resistive index (I.R.) was > 0.7. The A.A. think duplex Doppler US is a valuable addition to the standard sonographic evaluation to increase the diagnostic accuracy in patients with suspected renal obstruction.

[Echo-Doppler evaluation of the renal arterial flow in hepatic cirrhosis]. / Valutazione mediante eco-Doppler del flusso arteriolare renale in corso di cirrosi epatica.

In liver cirrhosis the sodium retention depends on a decreased renal perfusion by arteriolar vasoconstriction. To evaluate the usefulness of echo-Doppler in detecting such hemodynamic impairment, we studied 16 cirrhotic patients and 16 healthy subjects as control group. We measured Pulsatility Index (P.I.) and Resistivity Index (R.I.). Both parameters resulted to be statistically higher in cirrhotic patients than in controls; moreover they resulted to be higher in cirrhotics with ascites than in those without. Therefore echo-Doppler can detect intraparenchymal renal vasoconstriction in cirrhosis, this impaired perfusion is already evident before ascites formation.

[Echohysterography in the diagnosis of female sterility: preliminary results]. / L'ecoisterografia nella diagnostica della sterilità femminile: risultati preliminari.

Couple's study infertility sometimes need repeated hysterosalpingographical evaluations. In three cases the A.A. value echohysterosalpingography's utility. The echohysterosalpingography gives morphological and functional dates, is easy repeatable and the patients aren't exposed to ionizing radiations.

[Echography problems in acute scrotum: torsion of the hydatid of Morgagni]. / Problematiche ecografiche nello scroto acuto: torsione dell'idatide del Morgagni.

The A.A. discuss about a clinical case of acute scrotum in which the echographical aspects aren't been exhaustived for the etiology. Surgical exploration showed Morgagni's hydatid torsion while the echography doubted between acute phlogosis and neoplasia.

[Ureteral jet in patients with benign prostatic hypertrophy: prognostic evaluation during single and combined therapy]. / Il jet ureterale nei pazienti con ipertrofia prostatica benigna: valutazioni prognostiche in corso di terapia singola e combinata.

By color-Doppler ultrasound it's possible to visualize urine flow jet from ureter into the bladder. Aim of the study was to evaluate of ureteral jet in patients with benign prostatic hyperplasia before, during and after with one or two drugs medical therapy. Thirteen patients, aged 51-63 years, were studied; they were not affected by metabolic, hepatic, renal diseases and by prostate inflammation. Eco color Doppler p.w. (Toshiba SSA 270A) with a convex probe of 3.5 MHz was used. A transabdominal ultrasound study was performed, prostate volume measured and ureteral jet visualized before and along treatment (at six months interval) with Finasteride and at the end of treatment. Successively, in four patients, with relapse of prostatic synptomatology, a transabdominal ultrasound study was performed, before and along a treatment with Finasteride, 5 mg/die (Finastid, Neopharmed) and Terazosin hydrochloride, 5 mg/die (Teraprost, Malesci), and at the end of treatment.

[Pulsed-wave color Doppler echography of the intrarenal vessels in patients with insulin-dependent diabetes mellitus and incipient nephropathy]. / L'ecocolor Doppler P.W. dei vasi intrarenali nei pazienti con diabete mellito insulino dipendente (IDDM) e iniziale nefropatia.

Diabetic nephropathy affects a subset of about 40% patients with Insulin-Dependent Diabetes Mellitus (IDDM); it also develops in a less defined percentage (30-50%) of patients with non Insulin-Dependent Diabetes Mellitus (NIDDM), after a period of 15-20 years. It is usually divided in 5 stages: the first 3 are characterized by renal hypertrophy and increased glomerular filtration surface area (I stage) followed by glomerular histological lesions (II stage) and early nephropathy with microalbuminuria (III stage). At these stages nephropathy is still reversible by medical treatment (ACE inhibitors) and good metabolic control. Aim of this study was to assess the usefulness of duplex sonography with Doppler wave form analysis in the evaluation of early diabetic nephropathy, in order to detected patients at risk for irreversible renal disease. Fifteen patients (10 males and 5 females) aged 28-46 years, affected by IDDM were studied; 15 healthy subjects (7 males and 8 females) aged 20-45 years composed the control group. All of them underwent duplex Doppler sonography of kidney; a scanner with a 3.5 MHz transducer (Toshiba 270 SSA) was used. All patients had renal function tests within normal range. Pulsatily Index (P.I.) and Resistive Index (R.I. of Doppler waveform were obtained at the interlobar arteries; the average value of 3 bilateral measurements was taken. Doppler sonography was done by the same authors without knowledge of the patient group (case or control). Both indexes (P.I. and R.I.) resulted to have higher values in patients with IDDM compared to controls: P.I. = 1.46 +/- 0.30 vs. 1.07 +/- 0.06, p < 0.05; R.I. = 0.77 +/- 0.09 vs 0.60 +/- 0.03, p < 0.05. Even if our data have to be confirmed by further studies, they suggest that duplex Doppler sonography may be a useful complementary test in the evaluation of diabetic nephropathy, even in the early stages.

[Transrectal ultrasonography in the early diagnosis of prostate carcinoma: use of a new ultrasonography technique with endorectal probe]. / L'ecografia transrettale nella diagnosi precoce del carcinoma prostatico: utilizzo di una nuova manovra ecografica con sonda endorettale.

Seventy-80% of prostatic carcinoma develops in the peripheral gland. Transrectal ultrasound (TRUS) has the capacity to identify nodules or hypoechogenic areas in the peripheral zone, suspected to be carcinoma. We describe a new echographic technic with endorectal probe (target compression test), to study hypoechogenic areas or nodules in the peripheral gland, during TRUS examination. Thirty-three patients, aged 49-77 years, with prostatic peripheral hypoechoic lesion at transrectal ultrasound, were studied. All patients underwent prostatic biopsy. Ten of the 11 positive patients (non compressible lesion) at the target compression test resulted to be affected by adenocarcinoma. Only 3 of the 22 negative patients (compressible lesion) at the target compression test resulted to be affected by adenocarcinoma. Even if our data have to be confirmed by further studies, they suggest that the target compression test may be a useful complementary test, during TRUS, in the evaluation of hypoechogenic areas in the peripheral gland.

[Urethral echography: potential and limitations]. / L'ecografia uretrale: possibilità e limiti.

Since in the early years of 1980, the diagnostic for images about male's urethral injury was exclusively assigned to urethrocystography. Sially in repeated check the gonads too often are exposed to ionizing radiations. Our results show urethrocystography/ultrasonography good correlation (13/15) cases) with 86% sensibility. Even if the urethrocystography is a methodic of first instance, the urethral ultrasonography is efficacious in follow up of urethral injury, particularly in the study of anterior urethra.

[Echographic characteristics of calcifying fibrous pseudotumor of the epididymis]. / Aspetti ecografici dello pseudotumore fibroso calcificante dell'epididimo.

Calcifying fibrous pseudotumor of epididymis is a rare neoplasia. The A.A. report echographical aspects about two clinical acses examined in 1993. Peculiar aspects of tumour are characterized by acoustic obstruction of the fibrous tissue and contextual iperechogenic spots, so to stimulate a calcific pseudocapsula. The A.A. revalue the echographical images after surgical exploration and discuss about differential diagnosis with TBC.

[Echographic features in the diagnosis of renal abscess]. / Aspetti ecografici nella diagnosi di ascesso renale.

The Authors emphasize sonographic aspects of Renal Abscess in early phase and in proclaimed disease. The advent of the sonography and its extensive use marked an inversion of tendency in Perinephric Abscess evolution. So it is possible to point out small Abscesses and in early phase. Leukocytes tags Scintiscan and CT can confirm the diagnostic tentative.

[The area of focal nephritis measured by echography: useful indications in patients with unexplained back pain in comparison with other assessments]. / Le aree di nefronia focale all'ecografia: utili indicazioni in pazienti con inspiegabili dolori dorsali e confronto con altre indagini.

In some patients undergoing an U.S. study of kidney for lumbodynia, it's sometime possible to visualize hypoechoic and areas poorly demarcated without distal acoustic enhancement, localized within the cortex and disrupting the cortico-medullary junction. These findings, called focal nephritis, associated to minimal retention of urine in the bladder, reflect an inflammatory process involving the renal parenchyma, in spite of normal urine analysis. To confirm this theory, 7 patients who presented these findings at US study of kidney underwent renal scintigram with labeled granulocytes. This test revealed the presence of focal bacterial nephritis in the same hypoechoic areas. Therefore US study of kidney combined with renal scintigram is useful to diagnose inflammatory process of the kidney in patients complaining lumbodynia.

[Bile acids in the therapy of chronic liver diseases]. / Gli acidi biliari nella terapia delle epatopatie croniche.

In the last 10 years, interest about the employment of bile acids, especially of ursodeoxycholic acid (UDCA), in the treatment of chronic liver diseases has increased. The mechanism has not been completely explained yet, but this agent has been thought to act mainly by making bile less toxic for the liver cells, reducing the fraction of hydrophobic detergent bile acids. UDCA is effective in decreasing serum concentrations of liver enzymes in chronic liver diseases, especially in those associated with cholestasis. This effect discloses new perspectives about the employment of this agent, even in association with other drugs, i.e. interferon; however, further investigations will be necessary in order to standardize the use of UDCA in the treatment of chronic liver diseases.

Characterization of the normal pulmonary surface and pneumonectomy space by reflected ultrasound.

Interest has been increasing in the use of transthoracic ultrasound for the study of the pleuropulmonary disease. US imaging depends mainly on the physical interactions between ultrasound waves and the tissues being examined. In the thoracic region, the prescence of the chest wall and the air-containing pulmonary tissues cause various artifacts that strongly influence the resulting images. At the interface between tissues and air, the ultrasound beam is totally reflected and produces simple reverberation, comet-tail artifacts, and ring-down artifacts.We report the findings of transthoracic ultrasound in normal healthy subjects and in those who had undergone pneumonectomy.This experience shows that, in terms of the ultrasound artifacts mentioned above, the postpneumonectomy cavity is not significantly different from the healthy lung.

Role of thoracic ultrasound in the assessment of pleural and pulmonary diseases.

Although numerous studies have been conducted on the use of ultrasonography (US) for the examination of thoracic structures, this procedure is not as widely accepted as abdominal US. The newer portable scanners can be used at the bedside to detect pleural malignancies and effusions, as well as peripheral lung nodules of the lung, even in seriously ill patients. Focal thickening of the pleura can be easily detected with US and further investigated with a US-guided biopsy. US guidance can also be used during percutaneous drainage of pleural effusion or transthoracic biopsy of peripheral lung lesions, thus reducing the incidence of procedure-related pneumothorax to almost zero. We review the current literature on thoracic US and present our clinical experience with the technique in large groups of patients with pleural and peripheral lung diseases.

[Vascular pathology of urologic significance: Doppler and color Doppler]. / Patologie vascolari di interesse urologico: Doppler e color Doppler.

The combined use of B-mode ultrasonography and doppler (p.w. and/or color doppler) provides a more accurate and detailed study of vascular pathology than B-mode ultrasonography alone. In fact, besides to document the presence of blood flow and to assess its direction, doppler US provides a quantitative evaluation of blood flow. Chromatic codification of blood flow (usually red if flowing towards the probe, blue if flowing away from the probe and yellow or green in the case of turbulence) permits to assess the presence of blood flow even in areas where a vessel cannot be depicted by B-mode ultrasonography. In fact in the study of blood flow to the kidney it's possible with color-doppler to visualize not only the main renal arteries but segmental-intraparenchymal arteries too; that is very useful in the detection of rejection of allograft. In renal artery, blood flow presents a pattern of low resistance: a brief systolic phase followed by a longer diastolic one, without inversion of flow. In renal vein, blood flow is, on the contrary, continuous. The main disorders of the kidney and urinary tract, which can be detected by color doppler are the following: renal-vascular hypertension, rejection of allograft, renal vein thrombosis, portal hypertension with spleno-renal collateral channels, disorders of ureteral motility, space occupying lesions, medical nephropathies and obstructive uropathies. Sophisticated analysis of the flow pattern to the kidney with color doppler, by some doppler sonographic parameters (resistance index RI, pulsatility index PI), in these disorders adds a functional element to the traditional ultrasonographic imaging with a better characterization of the disease.

Immunocytochemical typing of fine needle aspirates by means of alkaline phosphatase anti-alkaline phosphatase method. A study of 16 selected patients.

The immunocytochemical characterization of neoplastic cells recognized by a large panel of monoclonal antibodies in fine needle aspirates obtained from 16 subjects with superficial or profound tumoral masses of unknown origin was carried out using alkaline phosphatase anti-alkaline phosphatase (APAAP) immunoenzymatic method. The patients were selected on the basis of particular clinical criteria or since a correct cytohistological diagnosis was not available. APAAP immunophenotyping allowed to establish the existence of non-Hodgkin lymphoma in 6 cases, hairy cell leukemia in 1 case and carcinoma in 5 cases, while in other 2 patients the existence of Hodgkin's disease was suspected and subsequently confirmed; only in 2 subjects diagnostic informations were lacking. Furthermore, the evaluation of growth fraction by means of Ki 67 monoclonal antibody revealed a high degree of malignancy in all cases of lymphoma. Although some cautions have to be considered in the interpretation of results, APAAP immunocytochemical typing of fine needle aspirates appears a simple and reliable noninvasive diagnostic tool in selected patients.

Cruveilhier-Baumgarten syndrome without esophageal varices: ultrasonographic diagnosis and echo-Doppler study.

Two cases of Cruveilhier-Baumgarten syndrome not clinically evident and without esophageal varices in patients with liver cirrhosis and portal hypertension are presented. The diagnosis was made by real-time ultrasonography, which showed echographic caput medusae with large afferent umbilical veins and efferent inferior superficial epigastric veins. Doppler flowmetry documented high blood flow rates in these collateral portal-systemic circulations, and this explained the absence of large varices at endoscopy. The role of massive spontaneous portal-systemic shunts in preventing the formation of other shunts and particularly esophageal variceal bleeding is discussed.

[Diagnostic imaging in hypertrophic pyloric stenosis]. / La diagnostica per immagini nella stenosi ipertrofica del piloro.

This report discusses hypertrophic pyloric stenosis (HPS) and the current approach to diagnostic imaging in the vomiting infant. Signs and symptoms include dehydration and vigorous gastric peristalsis with vomitus. Palpation of an olive-shaped firm muscular tumor is pathognomonic of this condition. The radiographic signs of HPS are well known. Previously published criteria for the sonographic diagnosis of HPS are discussed, these include: measurements of pyloric length, diameter and muscle thickness. The thickened muscle is the most discriminated and accurate one. It was concluded that real-time ultrasound is a simple, and reliable method for the diagnosis of HPS and should be the initial imaging procedure.