Leukotriene B4 and Peptido-Leukotriene Levels during Radiographic Contrast Media Infusion

The pathogenic mechanisms of radiographic contrast media (CM) reactions are still not well understood. Recently it has been proposed that leukotrienes (LT) may be involved in CM reactions. We measured plasma LTB4 and peptido-LT levels in 20 subjects undergoing urography with 2 low osmolality CM (ioxaglate and iopamidol) in order to elucidate if CM infusion determines LT release in plasma. LTB4 and peptido-LT did not change significantly during infusion of the 2 CM. Blood pressure, heart rate, and the number of circulating granulocytes were not affected by CM infusions, further evidence that LT release did not occur. We conclude therefore that LT are not released during infusion with the CM studied.

Liver steatosis (LS) evaluated through chemical-shift magnetic resonance imaging liver enzymes in morbid obesity; effect of weight loss obtained with intragastric balloon gastric banding

The aim of this study was to evaluate in morbid obesity clinical and metabolic effects related to weight loss on liver steatosis (LS), measured through chemical-shift magnetic resonance imaging (MRI) and liver enzymes. Forty obese subjects (8 M/32 W; BMI 42.8 ± 7.12 kg/m(2), mean ± SD) were evaluated for LS through ultrasound (US-LS), chemical-shift MRI (MRI-LS), liver enzymes [aspartate aminotransferase (AST), alanine aminotransferase (ALT), γ-glutamyltransferase (GGT), alkaline phosphatase (ALP)], anthropometric parameters [weight, BMI, waist circumference (WC)], lipids, insulin, insulin resistance (HOMA-IR), glycated hemoglobin (HbA1c), oral glucose tolerance test, and body composition [fat mass (FM) and fat-free mass (FFM) at bio-impedance analysis (BIA)]. Anthropometric measures, MRI-LS, BIA, and biochemical parameters were reevaluated 6 months later in 18 subjects undergoing restrictive bariatric approach, i.e., intragastric balloon (BIB, n = 13) or gastric banding (LAGB, n = 5), and in 13 subjects receiving hypocaloric diet. At baseline, US-LS correlates only with MRI-LS, and the latter correlates with ALT, AST, and GGT. After 6 months, subjects undergoing BIB or LAGB had significant changes of BMI, weight, WC, ALT, AST, GGT, ALP, HbA1c, insulin, HOMA-IR, FM, FFM, and MRI-LS. Diet-treated obese subjects had no significant change of any parameter under study; change of BMI, fat mass, and fat-free mass was significantly greater in LAGB/BIB subjects than in diet-treated subjects. Change of MRI-LS showed a significant correlation with changes in weight, BMI, WC, GGT, ALP, and basal MRI-LS. Significant weight loss after BIB or LAGB is associated with decrease in chemical-shift MRI-LS and with reduction in liver enzymes; chemical-shift MRI and liver enzymes allow monitoring of LS in follow-up studies.

Changes of liver fat content and transaminases in obese children after 12-mo nutritional intervention

AIM: To assess a relationship between longitudinal changes in liver fat content and biochemical parameters in obese children after 1-year nutritional intervention.

METHODS: Forty-six obese children, 21 males and 25 females, aged 6-14 years, underwent metabolic measurements, liver ultrasonography (US) and chemical-shift magnetic resonance imaging (MRI) examinations at baseline and after 1-year nutritional intervention. A child was defined obese if her/his body mass index (BMI) was above the age- and sex-adjusted BMI Cole’s curve passing through the cut-off of 30 kg/m² at 18 years. BMI Z scores were calculated and adjusted for age and gender by using the Cole’s LMS-method and Italian reference data. Biochemistry included serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Abdominal US and chemical-shift MRI were performed according to a randomized sequence. The same radiologist performed US by a GE Logiq 9 (General Electric Healthcare Medical Systems, Milwaukee, WI, United States) using a 3.5-MHz convex array transducer. Liver echogenicity was evaluated independently on videotape by 3 radiologists unaware of the child and MRI outcomes, and a consensus was established. Another experienced radiologist, unaware of the child and US data, performed the abdominal chemical-shift MRI with a 1-t system NT-Intera (Philips Medical Systems, Best, The Netherlands) and a phased-array coil. Liver fat fraction (FF) on MRI was judged elevated when greater than 9%. A FF > 18% was considered expressing more severe cases of fatty liver according to Fishbein. A nutritional-behavioral intervention was recommended to promote a normocaloric balanced diet and active lifestyle based on the Italian guidelines for treatment of childhood obesity.

RESULTS: Compared to baseline, at the end of intervention children showed lower intakes of energy (mean ± SD: 2549 ± 1238 Kcal vs 1770 ± 622 Kcal, P < 0.0001), total fat (90 ± 47 g vs 52 ± 23 g, P < 0.0001), carbohydrates (356 ± 174 g vs 241 ± 111 g, P = 0.001), and protein (99 ± 48 g vs 75 ± 23 g, P = 0.006) intakes. Prevalence of FF ≥ 9% declined from 34.8% to 8.7% (P < 0.01), with a mean reduction of 7.8% (95%CI: 5.0-10.6). At baseline, FF was associated with liver biochemical parameters (maximum P < 0.001). At the end of the intervention association was found with AST (P = 0.017). Change of FF was associated with change in AST (P = 0.027) and ALT (P = 0.024). Rate of increased liver echogenicity declined from 45.6% to 21.7% (P < 0.0001). Liver echogenicity was associated with ALT at baseline only (P < 0.001). An age- and sex- adjusted multiple regression analysis showed that FF change was independently associated with change in serum AST (adjusted regression coefficient 0.348, P = 0.048).

CONCLUSION: The results suggest that in obese children longitudinal changes in liver fat content based on MRI may be associated with change in serum transaminases suggesting novelty in monitoring nonalcoholic fatty liver disease.

Removal of radioisotopes in solution and bactericidal/bacteriostatic sterilising power in activated carbon and metal silver filters

Activated carbon filters play an important role in water filtration and purification from contaminants of different origin. Their limit consists in bacterial proliferation, which may occur only during prolonged periods of non-use and in their ability to remove radioactive contaminants present in waste water from Industry or Nuclear Medicine departments. In this work we tested a commercially available activated carbon filter for water purification enriched with silver plated parts incubating in static condition at room temperature different micro organisms (Enterococcus faecalis, Escherichia coli, Pseudomonas aeruginosa, Salmonella enteritidis, Staphylococcus aureus, Aspergillum niger), up to 78 days. The microbial growth was in general more inhibited in the presence of metal silver into the activated carbon in respect to filters with the activated carbon alone: >4log inhibition of bacterial proliferation after 78 days of incubation the presence of silver vs. 2log without silver. When the filters were incubated empty of carbon, the sterilizing power of silver was confirmed further. The activated carbon filters proved also their ability in removing from water the principal radioisotopes used for residues liquid medical and research purposes ((131)I, (99m)Tc, (201)Tl, (67)Ga). These results contribute useful data for the use of the silver-enriched carbon filters in water filtration both for daily use at home, and professional use in a Nuclear Medicine laboratory.

Usefulness of chemical-shift MRI in discriminating increased liver echogenicity in glycogenosis

BACKGROUND

Glycogen storage diseases are inherited defects which cause accumulation of glycogen in the tissues. Hepatic steatosis is defined as accumulation of fat within hepatocytes. On sonography, liver shows increased echogenicity both in glycogen storage diseases and steatosis. Liver hyperechogenicity in glycogen storage diseases may depend on accumulation of glycogen and/or fat. Chemical-shift magnetic resonance imaging can discriminate tissues only containing water from those containing both fat and water.

AIM

The primary aim of the present study was to evaluate the usefulness of liver chemical-shift magnetic resonance imaging for detecting liver steatosis in patients with metabolic impairment due to glycogen storage diseases.

SUBJECTS

Twelve patients with type I (n=8) or type III (n=4) glycogen storage diseases were studied and compared to 12 obese-overweight subjects with known liver steatosis. As control group 12 lean normal voluntary subjects were recruited.

METHODS

Liver was evaluated by sonography and chemical-shift magnetic resonance imaging to calculate hepatic fat fraction.

RESULTS

A significant difference in echogenicity between patients with glycogen storage diseases and normal subjects was observed (p<0.05), while this difference was not present between overweight-obese and glycogen storage diseases patients. On the contrary, fat fraction was similar between glycogen storage diseases patients and normal subjects and different between glycogen storage diseases patients and overweight-obese (p<0.05).

CONCLUSION

The present data suggest that chemical-shift magnetic resonance imaging may exclude fat deposition as a cause of liver hyperechogenicity in subjects with glycogen storage diseases.

Proteomic analysis of rat hippocampus after repeated psychosocial stress

Since stress plays a role in the onset and physiopathology of psychiatric diseases, animal models of chronic stress may offer insights into pathways operating in mood disorders. The aim of this study was to identify the molecular changes induced in rat hippocampus by repeated exposure to psychosocial stress with a proteomic technique. In the social defeat model, the experimental animal was defeated by a dominant male eight times. Additional groups of rats were submitted to a single defeat or placed in an empty cage (controls). The open field test was carried out on parallel animal groups. The day after the last exposure, levels of hippocampal proteins were compared between groups after separation by 2-D gel electrophoresis and image analysis. Spots showing significantly altered levels were submitted to peptide fingerprinting mass spectrometry for protein identification. The intensity of 69 spots was significantly modified by repeated stress and 21 proteins were unambiguously identified, belonging to different cellular functions, including protein folding, signal transduction, synaptic plasticity, cytoskeleton regulation and energy metabolism. This work identified molecular changes in protein levels caused by exposure to repeated psychosocial stress. The pattern of changes induced by repeated stress was quantitatively and qualitatively different from that observed after a single exposure. Several changed proteins have already been associated with stress-related responses; some of them are here described for the first time in relation to stress.

Abdominal ultrasonography in inheredited diseases of carbohydrate metabolism

PURPOSE

To determine the usefulness of abdominal sonography in inherited diseases of carbohydrate metabolism.

MATERIALS AND METHODS

Thirty patients (age range, 4 months to 27 years) with glycogen storage diseases, galactosemia, disorders of fructose metabolism were studied with sonography. Echogenicity of the liver, sonographic dimensions of liver, kidneys and spleen were evaluated. Plasma blood parameters (ALT, AST, total cholesterol, triglycerides) were determined.

RESULTS

Liver was enlarged in 21/22 patients (95.4%) with glycogen storage diseases, in both subjects with disorders of fructose metabolism, and in 2/6 patients (33.3%) with galactosemia. Hepatic echogenicity was increased in 20/22 patients (90.9%) with glycogen storage diseases, and in the subject with hereditary fructose intolerance. Patients with galactosemia did not show increased liver echogenicity. Both kidneys were enlarged in 8/17 patients (47.0%) with glycogen storage disease type I. Subjects with increased hepatic echogenicity exhibited higher plasma concentrations of any blood parameter than the others with normal echogenicity (p<0.05).

CONCLUSIONS

Sonography can be useful in identification of inherited diseases of carbohydrate metabolism even if further examinations are necessary for an ultimate diagnosis.

Cardiac and pulmonary calcification in a hemodialysis patient: partial regression 4 years after parathyroidectomy

AIMS

The reversibility of extraskeletal calcifications in dialysis patients is an important and unresolved issue. Although periarticular calcifications have been shown to be reversible, little data are available on vascular or parenchymal calcifications.

CASE HISTORY

A patient on maintenance hemodialysis with severe hyperparathyroidism, hypercalcemia and hyperphosphatemia was admitted to undergo parathyroidectomy. A preoperative total body bone scintigraphy was performed to better evaluate a lytic lesion in the pelvis, the histology of which proved to be a "brown tumor". The scan showed the typical findings of renal osteodystrophy, but also a diffuse extra-skeletal uptake of bone tracer in the lungs, kidneys, femoral arteries and myocardium. After surgery, good control of serum calcium, phosphate (Ca x P product < 50 mg2/dl2) and PTH levels was maintained during 4 years of follow-up. Bone scans were repeated after 2 and 4 years, showing marked improvement of periarticular uptake at the ends of long bones. Extraosseous calcium deposition was still markedly evident, but progressively decreased (at 4 years: heart -36%, lungs -18%).

CONCLUSION

In this dialysis patient, extraskeletal calcification of visceral organs (particularly in the heart and the lungs) due to prolonged hypercalcemia and hyperphosphatemia was partially reversible by parathyroidectomy followed by good long-term control of serum phosphate and calcium.

Sonographic findings in type I glycogen storage disease

PURPOSE

The aim of this study was to document the sonographic appearance and dimensions of the liver and spleen in patients affected by type I glycogen storage disease and to correlate those findings with laboratory data to evaluate the potential role of sonography in diagnosing that disease.

METHODS

Fourteen patients (age range, 3-26 years; 10 patients younger than 18 years) with type I glycogen storage disease proved by liver biopsy were studied prospectively with gray-scale sonography, color Doppler sonography, and spectral analysis. The liver, kidneys, spleen, portal system, hepatic veins, and hepatic arteries were evaluated. Laboratory data were correlated with sonographic findings.

RESULTS

In 13 (93%), of 14 patients, the liver was enlarged, and in 11 patients (79%), hepatic echogenicity was increased. In 9 patients (64%), both kidneys were enlarged, and in 6 cases (43%), the spleen was enlarged. In all patients, flow in the portal, splenic, and superior mesenteric veins was hepatopetal, and flow in the hepatic veins was triphasic. In 5 patients (36%), both triglyceride and total cholesterol levels were higher than normal. No focal hepatic lesions were identified. Analysis found no significant association between sonographic findings and laboratory data.

CONCLUSIONS

The most frequent sonographic findings in patients with type I glycogen storage disease were hepatomegaly, increased hepatic echogenicity, and enlarged kidneys. Sonography may help in the diagnosis of type I glycogen storage disease, but a liver biopsy is required for a definitive diagnosis.

Cardiac autonomic responses to intermittent social conflict in rats

Intermittent exposure to the same stressor can lead to a gradual decline in physiological, neuroendocrine and behavioral stress responses (habituation). We investigated possible habituation of cardiac autonomic responsiveness and susceptibility to cardiac arrhythmias in male rats exposed to either intermittent social victory (VIC) or defeat (DEF) stress (10 exposures in each case). Electrocardiograms were recorded via radiotelemetry and the sympathovagal balance at the level of the heart was evaluated via time-domain measurements of heart rate variability, namely average R--R interval (average time interval between two consecutive heart beats, RR), the standard deviation of RR (SD(RR)) and the root-mean-square of successive R--R interval differences (r-MSSD). Values of these parameters were significantly lower in DEF as compared to VIC rats in the second part of the test period (from Minute 6 to Minute 15), suggesting a more pronounced sympathetic dominance in the former group of animals. Accordingly, the occurrence of the most frequent cardiac arrhythmias (ventricular and supraventricular premature beats) was higher in DEF rats. Habituation of cardiac autonomic responsivity was observed across repeated exposure to victory, both in terms of sympathovagal balance and susceptibility to cardiac tachyarrhythmias, whereas no habituation was found in repeatedly defeated animals. A possible explanation to this discrepancy could be the different degree of controllability characterizing the two social challenging situations.

[Splenomegaly and hypersplenism in cirrhotic patients before and after orthotopic liver transplantation]

PURPOSE

To measure the spleen length in patients with cirrhosis and portal hypertension with US and compare the measurements before and after orthotopic liver transplantation. To correlate splenic measures with laboratory data and Doppler flowmetry (mean portal vein flow velocity).

MATERIALS AND METHODS

May, 1993, to January, 1997, fifteen patients with cirrhosis, portal hypertension and splenomegaly were examined and underwent orthotopic liver transplantation. The spleen length was measured before and after transplantation in 15/15 patients and it was also measured twice after transplantation in 10/15 patients. The mean portal venous flow velocity was measured before and after transplantation in 10/15 patients. The results were analyzed using the Student's t-test for paired and unpaired data; the association between the variables was evaluated by linear regression analysis; two-tailed p values were used.

RESULTS

At the first control after orthotopic liver transplantation (mean time from transplantation 5.5 +/- 2.6 months; range 2.5-12.5 months) a significant decrease was found in spleen length (179 +/- 32 to 149 +/- 30 mm, p = .0001; mean percent decrease = 16.7 +/- 9.9%), hypersplenism disappeared in 9/13 cases, mean portal venous flow velocity, measured in 10/15 patients, showed an increasing trend (16.0 +/- 9.0 to 22.3 +/- 9.0 cm/s). At the first control the correlation between the values of mean portal flow velocity measured before and after transplantation was not significant (r = .558, p = .0939); the same was true for the correlation between mean portal flow velocity and spleen length. The second measurement of the spleen length after transplantation (mean time from the first follow-up 18.1 +/- 7.8 months; range 6.4-32.8 months) in 10/15 subjects demonstrated no significant changes in the spleen dimensions relative to the first examination (139 +/- 24 mm to 138 +/- 26 mm), and in 1/10 case hypersplenism disappeared.

CONCLUSIONS

The measurement of the spleen length is proposed for the follow-up of the patients with cirrhosis and hypersplenism before and after orthotopic liver transplantation. In our study, the mean decrease in spleen length was 17% in the period from transplantation to the first US examination. In the patients who underwent a second measurement after transplantation no significant change in spleen length was observed.

[Diagnostic imaging in the selection of candidates to orthotopic transplantation of the liver. Experience at a hospital lacking a transplantation department]

We report the experience of our general hospital in selecting the patients for orthotopic liver transplantation (OLT). Fifty-one patients with cirrhosis were examined and 20 of them submitted to OLT from August, 1992, to November, 1995. For liver studies, the 20 transplant recipients were examined with US and plain and dynamic CT; 15/20 were submitted to CTAP, 10/20 to Lipiodol CT and 17/20 to angiography. The accuracy of these techniques in HCC detection was assessed by correlation with resected whole livers. The accuracy of duplex Doppler and color flow Doppler for portal and/or mesenteric vein thrombosis was evaluated by correlation with resected livers, CT and angiographic findings. Pathologic examinations diagnosed HCC in 5/20 transplant recipients: 2 lesions (1.5 cm and 2 cm; 2 cm and 3.5 cm) were found in 2 resected specimens (total hepatectomy) and 1 lesion was found in 3 cases (2.5 cm, 1.5 cm, 1 cm). The sensitivity of US, plain and dynamic CT in identifying HCC patients was 20%; US and CT specificity rates were 100% and 87%, respectively. CTAP sensitivity was 75% and the sensitivity of Lipiodol CT and angiography was 100%. Therefore, in our series, US was poorly sensitive in the detection of liver cancers, which may depend on the small number of patients, lesion size (< or = 3.5 cm) and the radiologists ignoring clinical and laboratory data on purpose. Nevertheless, the patients with a single HCC not exceeding 5 cm phi or with no more than 3 tumors, none of them exceeding 3 cm phi, are generally considered eligible for transplantation: therefore, our patients chosen for OLT on the basis of US and CT findings were actually eligible for transplantation in spite of US and CT false negative results. At US, the portal vein had an average caliber of 13.5 +/- 2.5 mm in 21/51 patients; the average caliber of the common hepatic artery was 6 +/- 1.5 mm in 49/51 patients; average spleen length was 174 +/- 38 mm. US showed ascites in 28/51 cases. In conclusion, considering also the long stand-by list for OLT, the first selection of transplant candidates could be performed with US and color flow Doppler, plain and dynamic CT. The patients who are ruled out as candidates for OLT on the basis of the findings of these imaging techniques and of clinical and laboratory findings are submitted to no further examination and referred to the transplantation unit. Otherwise, if conventional and color flow Doppler US and conventional CT are not enough to exclude a patient from OLT, the subject is submitted to more invasive (angiography, CTAP, Lipiodol CT) or less widespread (spiral CT, MRI) techniques.

[Traumatic rupture of thoracic aorta: review of a 10-year experience]

We retrospectively reviewed the diagnostic imaging examinations of 22 patients affected with traumatic rupture of the thoracic aorta acquired in a 10-year period. Our study was aimed at investigating if the diagnostic approach to these patients has changed in the last 10 years, especially relative to the extensive use of Computed Tomography (CT). All the patients in our series were submitted to chest radiography and aortography; only 15 of them were submitted also to CT. Plain radiography showed enlarged mediastinum and altered aortic profiles in 22/22 patients, rightward deviation of the trachea and nasogastric tube with downward displacement of the left mainstem bronchus and apical cap in 7/22 patients and associated pleuropulmonary injuries in 11 patients. CT image quality was poor because of artifacts in 5 patients, while it demonstrated mediastinal hematoma in 10 patients and associated aortic outline alterations in 5 patients. Aortography always showed the site and number of aortic ruptures. In our experience, aortography should be performed next if chest radiography suggests mediastinal hematoma. CT should be performed before aortography if chest radiography demonstrates no mediastinal hematoma but is not convincingly normal and the patient needs CT studies for associated head and/or abdomen injuries. In this case, if CT is technically correct and its results are normal, aortography needs not be performed, whereas if CT findings are abnormal or not convincingly normal, aortography is mandatory. In the future, the approach to aortic trauma could be modified by transesophageal echocardiography, Magnetic Resonance Imaging and spiral CT, but the results of these imaging methods must still be validated with further extensive studies.

[Transrectal prostatic echography in the study of hemospermia. An assessment of an 85-patient case load]

Eighty-five patients with hemospermia were examined with blood tests, sperm culture, transrectal US (TRUS) and cystourethroscopy. Blood tests and sperm culture demonstrated bacterial inflammation in 48 patients (56.47%). At cystourethroscopy, the urethra was normal or hyperemic in all patients. TRUS demonstrated 40 cases (47.05%) of periurethral calcifications and also with calcifications in the two glandular lobes. TRUS also demonstrated prostatic inflammation in progress or its outcome in 21 patients (24.70%), ectasia and seminal vesicle inflammation in 10 patients (11.76%), a prostatic tumor in 3 patients (3.52%). No patient had cysts, stones or cancers in the seminal vesicles. In 11 patients (12.94%), no specific cause of hemospermia was detected, even though 4 of these patients (4.70%) had received anticoagulants for former heart ischemia. Benign prostatic hypertrophy was found in 44 patients (51.76%) but we did not consider it a possible cause of hemospermia because of the high frequency of this condition in the male population. To conclude, TRUS could demonstrate the cause of hemospermia in most of our patients, which makes us suggest it as the diagnostic technique of choice in the patients with ejaculatory conditions, after clinical exams and laboratory tests, because it allows to study the prostate, the seminal vesicles and the urethra.

[Comparison between portography-CT and lipiodol-CT in the staging of hepatocellular carcinoma]

Eighteen patients (13 men and 5 women) with uni- and multifocal hepatocellular carcinomas (HCC) were examined. Mean patients age was 63.3 years (range: 47-74 years). All patients had alcoholic or posthepatitis cirrhosis; they were submitted to both CT during arterial portography (APCT) and Lipiodol-CT. The diagnosis of HCC was confirmed by fine-needle biopsy (FNB) in all cases. APCT and Lipiodol-CT results were compared for number, size and site of lesions-32 lesions in all. APCT demonstrated all the lesions: 9 of them were smaller than 2 cm, 14 ranged 2-5 cm and 9 were bigger than 5 cm; moreover, APCT demonstrated other lesions in 3/18 patients (16.6%) which had been missed by US, CT and angiography. Also Lipiodol-CT demonstrated all the 32 lesions and showed smaller lesions in 4/18 patients (22.2%); these nodules were smaller than 2 cm. Based on APCT results 11/18 patients (61.1%) were considered operable, vs. 7/18 patients (38.8%) based on Lipiodol-CT results. To conclude, both APCT and Lipiodol-CT are useful in the preoperative staging of HCC; Lipiodol-CT is preferable to APCT in the study of lesions smaller than 2 cm.

Anthropometric or ultrasonic measurements in assessment of visceral fat? A comparative study

The main aim of the study (study 1) was to compare the accuracy of anthropometric and ultrasonic measurements in assessing the amount of visceral adipose tissue. An additional aim (study 2) was to verify ultrasound technique precision. Study 1: using computed tomography (CT) L4-L5 adipose tissue area as a gold standard we compared the accuracy of waist/hip circumference ratio, sagittal diameter and ultrasonic measurements of intra-abdominal depth in assessing the amount of visceral adipose tissue. Study 2: ultrasonic measurements of the intra-abdominal muscle-vertebra distance were made in triplicate by three different operators. In study 1, 24 volunteers were used; body mass index (BMI): 19-43. In study 2, 22 volunteers were used; BMI 20-42. In study 1, ultrasonic measurements of the abdominal depth correlated best with CT visceral adipose tissue area (r = 0.89 - 0.91). In study 2, inter-operator and intra-operator mean variation coefficients were about 7% and 5% respectively. We concluded that using a well standardized technique and properly trained operators, ultrasonic measurement of intra-abdominal depth is a valid method in assessing the amount of visceral adipose tissue.

Blunt trauma of the spleen: the delayed rupture in computed tomography

We retrospectively reviewed CT scans of 18 patients (12 males and 6 females; mean age: 43.6 years) with the diagnosis of blunt splenic trauma. All patients underwent CT at different times after the trauma. The cases were divided into 2 groups: according to the time at which the CT was performed, the 1st group consisted of 11 patients scanned within 48 h after the trauma; the 2nd group consisted of 7 patients studied with CT at variable times after the traumatic event (mean time: 6.5 days; range 3-13 days). All lesions in the 1st group (11 patients) had indistinct margins, while lesions of patients in the 2nd group (7 patients) always showed clean-cut and regular edges. Early lesions were always hyperdense, late ones hypodense. CT diagnosis always matched the surgeon's diagnosis. We can confirm the diagnostic value of CT of splenic lesions in blunt abdominal traumas.

[An analysis of a case series of 342 short-stature patients examined by the Tanner-Whitehouse 2 (TW2) method]

342 short-stature patients were examined to assess the agreement between anagraphic and bone ages. 190 men and 152 women (age range: 0 to 17.5 years) underwent conventional radiographs of the left wrist. The radiographs were studied with the TW2 method which provides an index of the skeletal maturity of short and long bones and a global index of the hand. The bone ages thus obtained were compared with anagraphic ages. Patients' statures were compared with their parents' ones. Finally, radiation exposures were evaluated. Anagraphic and bone ages were in agreement in 199 patients and in disagreement in 220. Three patients were adult. The short stature in 78 patients was in agreement with their parents' one, while 253 patients had at least one parent with normal stature. No comparison could be made in 11 patients. In conclusion, TW2 is a simple method to calculate bone age (in months and years) and to select the patients to submit to further examinations and to hormone therapy.

[Radiographic enlargement in the study of hand diseases. Digital versus conventional techniques]

The electronic magnification of digital images was compared with direct digital magnification and with plain radiograph magnification. A whole-body computed radiographic system with photostimulable phosphor plates contained inside standard X-ray cassettes was used. The small bones of the hands and wrists of 18 patients with traumatic (10 cases) or degenerative (8 cases) bone conditions mainly due to chronic renal failure were studied. Each patient was examined with all three techniques: the images were retrospectively reviewed by four observers relative to resolution, contrast, visibility of the lesions and diagnostic value of each method. The statistical analysis of our results demonstrated better yield of direct digital magnification than of plain radiograph (p = 0.00043) and of electronic (p = 7.5 10(-13) magnification. This finding was mainly due to density and contrast optimization of digital images, in spite of their low spatial resolution. This feature allows good simultaneous representation of structures with different radiographic densities, as it happens in the hand and wrist. Electronic magnification yielded less brilliant results, even if compared with plain radiographic studies (p = 0.0032). However, this limitation was compensated for by the fact that this technique is easier and quicker to perform and that it does not require any additional X-ray exposure.

[Arterial CT in the diagnosis of hepatocellular carcinoma: initial experience with 12 patients]

Intra-arterial CT of the liver is a valuable method to evaluate hepatocellular carcinoma (HCC). It consists of an infusion of contrast medium into the hepatic artery during CT scanning. Twelve patients with suspected resectable HCCs were evaluated with CT arteriography before surgery. The results of CT arteriography were compared with those of US, of CT with intravenous contrast medium and of angiography; on the rule, all exams had been performed some days earlier. The diagnosis of HCC was confirmed by US-guided fine-needle biopsy. CT arteriography demonstrated liver lesions in 11 patients. The lesions were hyperdense in 3/11 patients (27.3%) and hypodense and surrounded by a hyperdense ring in 8/11 patients (72.7%). In 4 of 11 patients (36.4%) CT arteriography identified additional tumor nodules and thus surgery was excluded. In the latter cases, on the basis of CT arteriographic findings, US, CT with i.v. contrast medium and angiography were repeated but failed to demonstrate the additional nodules, either because they were too small or because of cirrhotic changes in liver parenchyma. Therefore, CT arteriography is recommended in the evaluation of selected patients, especially when detailed information on liver parenchyma is needed--e.g., before surgery. In these patients CT arteriography can be performed together with preoperative angiography.

Diagnostic imaging of acute rupture of the thoracic aorta by blunt trauma

Ten patients with acute rupture of the thoracic aorta by blunt trauma were studied. In all instances chest radiographs, computed tomography and aortography were performed. A diagnostic algorithm is proposed for subjects with suspected acute rupture of the thoracic aorta.

[Abnormalities of the hepatic artery++ in relation to portal hypertension surgery. Study with angiography and echography]

This study was aimed at investigating the occurrence of hepatic artery variants, at comparing the diagnostic value of duplex Doppler US with that of angiography, and at correlating the results with the technical problems in portal hypertension surgery. All patients were studied with angiography, conventional and duplex Doppler US. In 162 patients with portal hypertension, 38 hepatic artery variants (23.4%) were observed and classified according to Michaels. The commonest variant recognized by angiography was right hepatic artery arising from superior mesenteric artery (type III according to Michaels). US demonstrated hepatic artery variants in 9/162 patients (5.5%). At surgery, variants were found in 3/162 subjects (1.8%) and caused surgical problems in 2 of them (1.2%) - i.e., right hepatic artery arising from superior mesenteric artery. Arteriography is still the best examination to depict hepatic artery variants, while duplex Doppler US demonstrates only a few types. Moreover, the number of variants detected by imaging techniques (23.4%) differs greatly from that observed at surgery (1.8%). Finally, hepatic artery variants are not correlated with surgical problems, nor can the latter be foreseen by imaging methods. US is useful but not essential to detect hepatic artery variants which are subsequently confirmed by angiography.

[Comparison of portal CT, arterial CT and CT with intravenous contrast media in the diagnosis of hepatocarcinoma]

Sixty-nine patients underwent CT for hepatocellular carcinoma (HCC). All subjects were examined with CT before and after bolus injection of contrast medium: 42 HCCs were detected. 13/42 patients underwent also CT arteriography (contrast medium in the hepatic artery) and 29/42 were submitted to CT during arterial portography (contrast medium in the superior mesenteric artery). The results of the three techniques were compared with each other and with surgical and pathologic findings. CT during arterial portography detected other lesions in 5/29 patients while it confirmed CT diagnosis in the extant 24 cases; CT arteriography recognized other lesions in 2/13 subjects while in the extant 11/13 it confirmed CT diagnosis. Both CT arteriography and CT during arterial portography affected treatment protocol in 16.2% of cases. The results had surgical confirmation in all patients but 3 in whom intraoperative US showed some nodules undetected earlier. All the lesions were hypodense on CT during arterial portography. On CT arteriography, they were hyperdense in 4/13 cases and hypodense with an irregular hyperdense halo in 9/13 cases. To conclude, CT during arterial portography and CT arteriography are better diagnostic tools than CT: nevertheless, they are invasive techniques and should be employed in selected cases only.

[Role of computed tomography in splenic blunt trauma]

The CT scans of 18 patients (12 males and 6 females; mean age: 43.6 years) with splenic blunt trauma were reviewed. CT examinations had been made at different times after trauma. The CT images were grouped according to the time of examination and both structure and densitometry were evaluated in all lesions. In all cases CT findings were correlated with surgical and pathologic data. The patients were divided into two groups: group I included 11 subjects in whom CT had been performed within 48 hours following trauma and group II included 7 patients who had undergone CT at different times after trauma (3-13 days; mean: 6.5 days). All the lesions in group I exhibited blurred outlines, while the lesions in group II had clear-cut margins. The lesions in group I were always hyperdense while those in group II were hypodense. CT diagnosis was always in agreement with surgical findings. In conclusion, we confirm the value of CT in the examination of splenic lesions by blunt abdominal trauma. The evolution of splenic lesions is usually typical: CT yields useful information for injury evaluation and is therefore very important to plan treatment. We believe that CT should be performed as soon as possible, even on the basis of minor clinical and laboratory data.

[Computerized tomography and conventional radiography in the diagnosis of destructive spondyloarthropathy. Our experience with 30 patients undergoing periodic hemodialysis]

Thirty patients of both sexes (15 males and 15 females) with chronic renal failure who had under gone hemodialysis for 2-184 months (mean 45.1 months) were examined with conventional radiographs of the cervical spine and thin-layer CT of C4-C5-C6 to evaluate the radiographic patterns of destructive spondyloarthropathy. The radiographic patterns obtained with conventional and CT exams were compared with one another and with clinical (carpal tunnel syndrome) and biochemical data (alkaline phosphatase, parathormon, Ca, P, Ca/P, Al, beta 2-microglobulin). DSA (erosion and narrowing of the intervertebral space, collapse of the vertebral body and erosion of the vertebral plates) was recognized in 7 patients with conventional radiographs and in 11 patients with CT thanks to greater CT capabilities to recognize minimal osteolytic lesions of the vertebral body. All the patients with destructive spondyloarthropathy had personal and hemodialysis age higher than those without destructive spondyloarthropathy: 59.3 vs 57.7 years; 49 vs 39 months. Parathormon and alkaline phosphatase were increased while beta 2-microglobulin was normal. Only 2 patients with DSA had carpal tunnel syndrome. In conclusion, CT is a valuable technique for the diagnosis of destructive spondyloarthropathy but it must be performed only after conventional radiographs of the cervical spine or in the presence of clinical signs of destructive spondyloarthropathy (parathormon and beta 2-microglobulin increased, long-term hemodialysis).

[The hemodynamic significance of the angiographic changes after portasystemic shunting interventions for portal hypertension]

Seventy-two patients (52 males and 20 females, mean age: 50.6 years) were studied. They had undergone distal splenorenal shunts according to Warren and its modifications for portal hypertension. All patients were examined with digital and/or conventional angiography preoperatively and 15 days postoperatively. Preoperative and postoperative angiography was employed to evaluate the changes in vessel diameters including the hepatic, splenic and superior mesenteric arteries, the splenic, superior mesenteric and portal veins; the length of the main axis of the spleen was also measured. Furthermore, the degree of hepatic portal venous perfusion was evaluated according to the degree of portomesenteric-gastrosplenic disconnection. After surgery, the length of the main axis of the spleen is reduced and the hepatic artery diameter is increased, which are both signs of preserved hepatic flow and of reduced hypertension in the splanchnic venous system. The postoperative degrees of portal perfusion were correlated with the degrees of disconnection. In conclusion, the role is emphasized of early angiographic examinations after distal portosystemic shunts according to Warren to evaluate postoperative hemodynamic changes.

Leukotriene B4 and peptido-leukotriene levels during radiographic contrast media infusion

The pathogenic mechanisms of radiographic contrast media (CM) reactions are still not well understood. Recently it has been proposed that leukotrienes (LT) may be involved in CM reactions. We measured plasma LTB4 and peptido-LT levels in 20 subjects undergoing urography with 2 low osmolality CM (ioxaglate and iopamidol) in order to elucidate if CM infusion determines LT release in plasma. LTB4 and peptido-LT did not change significantly during infusion of the 2 CM. Blood pressure, heart rate, and the number of circulating granulocytes were not affected by CM infusions, further evidence that LT release did not occur. We conclude therefore that LT are not released during infusion with the CM studied.

Acute posttraumatic rupture of the thoracic aorta: the role of angiography in a 7-year review

Between 1983 and 1989, 15 patients with acute rupture of the thoracic aorta by blunt trauma were seen. Superior mediastinal widening and obscuration of the aortic arch were the most important findings on chest radiograph. Computed tomography examinations in 7 patients showed mediastinal hematomas but did not reveal aortic lesions. Definitive diagnosis of traumatic aortic rupture was established by aortography in all 15 patients. Intraarterial digital subtraction angiography proved to be as accurate as conventional film aortography and saved time.

[Pure and diluted contrast media in the visualization of the portal venous system using digital angiography]

We report the results of intra-arterial digital subtraction angiography (DSA) in 100 patients with portal hypertension. The portal venous system was evaluated; all patients underwent angiography of the celiac and superior mesenteric arteries before surgery. Forty-four of them were also examined after Warren splenorenal shunts. Therefore, a total of 144 exams was evaluated. The authors always employed low-osmolality ionic and non-ionic contrast media (iodine concentration: 300-350 mg/ml). In 70 cases pure contrast medium was injected (20-25 ml); in the extant 74 cases it was diluted with an equal volume of saline solution (osmolality and iodine concentration reduced by 50%). Intra-arterial DSA always visualized portal venous system, collateral circulation, shunt location and postoperative changes. The major advantage of intra-arterial DSA is the smaller amount of contrast medium injected, so that local and systemic side effects are rare. According to our experience, it is best to dilute the contrast medium and inject the same amount as in conventional angiography, at the same rate. Other well-known advantages of intra-arterial DSA are quicker execution, less injury to arteries using smaller-caliber catheters, and low cost. The major disadvantage of intra-arterial DSA, as it appeared also in our study, is the field size of the intensifier, which in our case was limited to 6-9 inches. This is an insufficient coverage for the whole portal system to be studied, and some contrast medium injections become therefore necessary. An average of 3 injections were given to each patient. This problem reduces the advantage of less contrast medium per injection. At any rate, even though intra-arterial DSA exhibits this limitation, it can nevertheless yield important information in the pre- and postoperative evaluation of patients with portal hypertension.

Digital subtraction angiography of the kidney

Intravenous and intra-arterial digital subtraction angiography (DSA) was performed in 88 patients: 34 with tumours, 10 with renal trauma, 26 with suspected renovascular hypertension, 6 with vascular impression on the renal pelvis, 8 with nephrolithiasis and 4 with sonographically abnormal kidneys. Venous and arterial DSA always gave diagnostically useful images. Intravenous DSA is valuable in patients with suspected renovascular hypertension or after vascular surgery, percutaneous transluminal angioplasty and transcatheter embolisation. Arterial DSA is preferable to venous DSA in other clinical situations, particularly in the evaluation of renal tumours, and may be recommended in preference to conventional angiography.

[Use of magnetic resonance in patients with portal hypertension before and after diversion intervention. Initial experience in 15 cases]

Fifteen patients with portal hypertension were examined by magnetic resonance imaging (MRI) using spin-echo sequences. Sagittal and transaxial images were obtained in all cases. Ten subjects have been evaluated after portosystemic shunt operations (6 portocaval and 4 splenorenal shunts); 5 patients were studied by MRI before shunt placements. Angiographic correlation was obtained in 15 cases. In each of the preoperative examinations, MRI accurately depicted inferior vena cava, portal vein and splenic vein. Shunt patency was documented in 10/10 postoperative studies: portacaval shunts patency was better determined in the transaxial plane while splenorenal shunts were better demonstrated in the sagittal plane. Thus, MRI seems to be an accurate and noninvasive method for detecting portosystemic shunt patency without the use of intravenous contrast media and without patient exposure to radiation.

[Echocardiographic gating in non-cardiac digital angiography]

This paper reports the results of the ECG-gating in non-cardiac digital subtraction angiography (DSA). One hundred and fifteen patients underwent DSA (126 examinations); ECG-gating was applied in 66/126 examinations: images recorded at 70% of R wave were subtracted. Artifacts produced by vascular movements were evaluated in all patients: only 40 examinations, carried out without ECG-gating, showed vascular artifacts. The major advantage of the ECG-gated DSA is the more efficient subtraction because of the better images superimposition: therefore, ECG-gating can be clinically helpful. On the contrary, it could be a problem in arrhythmic or bradycardic patients. ECG-gating is helpful in DSA imaging of the thoracic and abdominal aorta and of the cervical and renal arteries. In the examinations of peripheral vessels of the limbs it is not so efficient as in the trunk or in the neck.

[Efficiency of tetracaine in digital angiography of the blood vessels of the neck]

Deglutition artifacts often degrade diagnostic quality in digital subtraction angiography (DSA) of neck vessels. In order to reduce this drawback, the authors gave a local anesthetic (Tetracaine) to the patients undergoing DSA of aortic arch and carotid arteries. Hundred-twenty-three subjects divided into two groups were examined: Tetracaine was administered to one group (64 patients) and not to the other (59 cases). In the first group deglutition artifacts were not noted in 59/64 cases. Among those patients not treated with Tetracaine/deglutition artifacts were absent in 45/59 cases. This local anesthetic did not produce important toxic reactions. Therefore the authors believe that administration of local anesthetics can reduce deglutition artifacts in DSA of neck vessels.

[Periarticular calcifications. A little-known sign of psoriatic arthritis]

The hands of 40 patients with psoriasis were examined by conventional and direct magnification radiograms. In 5 cases the hands showed typical psoriatic arthropathy. In 5 other cases only small calcifications in the soft tissues at distal interphalangeal joints were visible: according to clinical and laboratory data, these lesions could be in connection with psoriatic arthritis.