Ultrasound imaging in diagnosis of superior mesenteric artery syndrome

OBJECTIVES

We screened a cohort of subjects affected by various degree of dyspepsia to reveal if they presented a reduction of the aorto-mesenteric angle and to diagnose suspected cases of superior mesenteric artery (SMA) syndrome.

DESIGN

Controlled, prospective, study.

SETTING

Subjects were studied as outpatients.

SUBJECTS

The study investigated a total of 3622 subjects referred to our department by their general practitioners for dyspepsia and/or abdominal pain. Interventions. Abdominal ultrasonography with power colour Doppler, gastroduodenoscopy, hypotonic duodenography, contrast-enhanced spiral computerized tomography were performed. MAIN OUTCOME MEASUREMENT AND RESULTS: Color Doppler revealed a significant reduction of the SMA angle in 29 of 950 subjects; gastroscopy showed duodenal compressive pulsation in 14 of 29 patients and X-ray revealed compression of the third segment of the duodenum in 28 of 29 patients. CT confirmed the presence of a reduced angle and various degrees of duodenal compression in all patients. Ultrasonography and CT examinations gave overlapping results (P > 0.05) in diagnosing pathological aorto-mesenteric angle.

CONCLUSION

The authors believe that the incidence of reduced aorto-mesenteric angle and SMA syndrome might be underrated. Ultrasound power colour Doppler imaging is useful in epidemiological screening of reduced aorto-mesenteric angle to diagnose suspected cases of SMA syndrome.

Ultrasonography in diagnosis and evaluation of fibrocystic liver diseases: two case reports

This paper describes 2 cases of a rare biliary cystic disease. A patient with Caroli's disease and another with bile duct swelling that were initially diagnosed by ultrasound and power color Doppler. Diagnosis was later confirmed by additional instrumental examinations. The first case was totally asymptomatic and only identified by chance, while the second was symptomatic and determined severe pain and dyspepsia. In both pathologies US B mode imaging and power color Doppler examination revealed the characteristic lesions of the intrahepatic biliary tree diseases and ruled out their vascular nature and communication with the portal and arterial tree.

Changes in splenoportal axis calibre and flow in a patient affected by hereditary angioedema

The authors describe a case of hereditary angioedema characterised by abdominal pain accompanied by ascites. Ultrasound (US) examination performed after acute abdominal attack implied the presence of increased splenoportal axis calibre and reduced blood flow. According to the authors, this may confirm the pathogenic role of C1-inhibitor deficiency induced oedema that is capable of creating major haemodynamic involvement also of abdominal vessels. US findings of transient appearance, especially related to the specific treatment, may help physicians make early diagnosis and avoid dangerous invasive procedures resulting from incorrect diagnosis of acute abdomen.

Association of alpha-interferon and acetyl cysteine in patients with chronic C hepatitis

BACKGROUND

Numerous experimental findings have underlined the relationships between liver damage and production of oxygen-derived free radicals during inflammation. In chronic hepatitis C liver disease this damage may be attributed to altered oxide-reductive balance and glutathione (GSH) depletion. Moreover, it may be linked to chronic inflammation provoked by the replicative activity of the hepatitis C virus and its relationships with immune system cells. Our aim was to assess the effects of combined IFN + NAC treatment to compare the effects of interferon alpha-n1 associated with N-acetyl cysteine treatment with the results observed using interferon therapy alone.

METHODS

EXPERIMENTAL DESIGN

prospective randomised study.

SETTING

Ambulatory and hospitalised care.

PATIENTS

77 selected patients affected by chronic C hepatitis.

INTERVENTIONS

our patients were investigated by laboratory tests (ALT values, RIBA test, HCV-RNA, oxide-reductive balance), liver biopsy and liver US. The recruited subjects were treated with interferon and N-acetyl cysteine or with interferon alone.

RESULTS

Our findings confirmed the presence of oxidative stress in patients with chronic hepatitis C and showed earlier relapse in patients treated with interferon alone. The difference between the results in patients treated with interferon and N-acetyl cysteine and those on interferon alone was significant.

CONCLUSIONS

The good results and absence of side effects in patients treated with interferon + N-acetyl cysteine recommend wider use of this association.

Perihepatic lymphadenopathy in chronic hepatitis C: a complementary diagnostic element?

BACKGROUND AND AIMS

The authors searched for perihepatic lymph nodes during ultrasonography performed for other symptoms in 1222 Sicilian outpatients in order to assess the incidence and possible significance of the association of perihepatic lymph nodes and chronic hepatitis C.

METHOD

One or two lymph nodes were observed in 184/1222 patients, and 142 of these 184 were anti-hepatitis C virus (HCV) positive.

RESULTS

Our results confirmed a very high incidence of perihepatic lymphadenopathy during chronic hepatitis. The concomitant presence of HCV virus and perihepatic lymph nodes may confirm the marked lymphotropism of this virus.

CONCLUSION

As anti-HCV positivity is frequent in asymptomatic subjects with normal alanine aminotransferase concentrations, the authors believe that searching for sentinel perihepatic lymph nodes during abdominal ultrasonography could be recommended in routine diagnostic screening for HCV infection. Any perihepatic lymph nodes detected by this method could pinpoint subjects for whom more specific examinations are required, especially in areas where the virus is particularly endemic.

[A case of deep vein thrombosis]

The case of a woman admitted to hospital various times because of the onset of a mantle-like oedematous syndrome is reported. Observations revealed a narrowing at the level of the internal jugular and right subclavian veins with total obliteration of the right anonymous vein caused by previous thrombosis induced by intravenous implantation of a pace-maker.

[A rare case of juvenile diabetes mellitus associated with APECED (autoimmune poly-endocrinopathy, candidiasis and ectodermal dystrophy) with strong X-linked familial inheritance]

The polyglandular autoimmune syndromes (PGA) are well known and are distinguished into type I, type II and type III. PGAI, also called APECED (autoimmune polyendocrinopathy, candidiasis and ectodermal dystrophy), is an autosomal recessive disorder, appearing in childhood and typically characterized by hypoparathyroidism (unusual in PGAII and PGAIII) and adrenal insufficiency. In APECED, autoimmune destruction of the pancreatic beta cells with development of insulin-dependent type 1 diabetes is possible, but less frequent than in the other PGAs, especially PGAII. The pathogenesis of this unique autoimmune disease is unknown. No HLA association seems to exist and genetic studies have assigned the autosomal APECED locus to chromosome 21. The case of a 28-years-old female suggesting the diagnosis of APECED, is presented, characterized by psycho-somatic abnormal development, teeth alterations, post-puberal gonadal failure with dystrophic hypoplasia of external genitalia, previous vaginal candidiasis, a slowly developing juvenile brittle diabetes. Intestinal malabsorption induced by Giardia lamblia occurred (probably resulting, like candidiasis, from immunological anergy). A strong familiarity linked to female sex was noticed (the mother, a sister, the little nice and some maternal female cousins being affected) while the father and a brother were healthy. Diabetes seems to be characterized by early onset and severe complications. In this patient no organo-specific antibodies were detected and the only immunologic disorder was a small decrease of CD3 and CD4/CD8 ratio, both CD4 and CD8 being at the lower normal range. This patient (and her female maternal relatives) needs a long-term follow-up in order to evaluate the function of endocrine glands and to initiate early treatment for hormonal deficits, as well as to detect the non-endocrine components of disease.