[Role of sonography in the evaluation of parotid gland in HIV+ children undergone highly active antiretroviral therapy (HAART)]. / Ruolo dell'ecografia nello studio della ghiandola parotide in bambini HIV+ sottoposti a terapia farmacologica antiretrovirale combinata. (HAART: "Highly active antiretroviral therapy").

PURPOSE: To evaluate the role of sonography (US) in the evaluation of parotid gland alterations in HIV+ children, in order to show their presence, severity, specificity, relationship with clinical and laboratory data and sensitivity to new drugs. MATERIAL AND METHODS: From June 2000 to December 2000 twenty-two consecutive HIV+ children (12 males and 10 females, mean age 9.7) undergoing HAART were prospectively examined with US. A multi-frequency linear probe (7.5-10 MHz) was used for the examination. The glands were assessed for alterations in gland volume and vasculature, hypoechoic foci, hyperechoic striae, lympho-epithelial cysts and solid nodules and the enlargement of intraparotid and adjacent lympho nodes. The US findings on HIV+ patients were compared with the patients'clinical and laboratory data and with US exams performed on HIV- children. Finally, we made a comparison with US exams performed on the same patients before HAART: RESULTS: In HIV+ children the most frequent US findings were hypoechoic foci (68.2% of patients), hyperechoic striae (68.2%) and the enlargement of intraparotid and adjacent lympho nodes (86.3% and 95.4%, respectively). No relationship between US outline and clinical and laboratory data was found. In the control group (HIV-negative children) hypoechoic foci and hyperechoic striae were rare (4.7% and 14.3%, respectively), while the enlargement of intraparotid and adjacent lympho nodes was very common (76.2% and 100%, respectively). The comparison with US exams performed on the same patients before HAART showed an improvement in 59.1% of patients, no improvement in 13.6% and a worsening in 13.6% (3 patients were lost to follow-up). DISCUSSION AND CONCLUSIONS: US is useful in the study of parotid gland alterations in HIV+ children. The most frequent specific US findings were hypoechoic foci and hyperechoic striae, whereas the enlargement of intraparotid and adjacent lympho nodes was frequent but completely aspecific. The analysis of results did not show any relationship between the US findings and clinical and laboratory data. HAART can be correlated to an improvement and/or a stabilization of the US pattern in most patients.

[Role of color Doppler echography in the visualization of perianal fistulae with injections of physiologic solutions]. / Ruolo dell'eco color Doppler nella visualizzazione delle fistole perianali mediante iniezione di soluzione fisiologica.

PURPOSE: To prove the diagnostic value of color Doppler US in the evaluation of perianal external fistulae, using an endocavitary probe and a saline solution injection, in order to show the location of the fistulae, their extension, possible secondary tracts, residual abscesses and the relationship with adjacent tissues. MATERIAL AND METHODS: From October 1999 to December 1999, thirty-five consecutive patients (21 males and 14 females, mean age 47.5) affected with Crohn's disease were examined prospectively. These patients presented postoperative recurring external perianal fistulae. From this first group, 10 patients (6 males and 4 females, mean age 45) were selected as the external fistula was open. A biplanar transrectal 7.5 MHz probe was used for the examination. First the external opening of the fistula was cannulated with a soft plastic catheter. Then the probe, covered with a lubricated condom filled with US gel, was introduced into the anal canal (males) or the vagina (females). An initial gray-scale US study was performed. Finally the color-box was positioned on the tract, the Pulse Repetition Frequency (PRF) adjusted and the saline solution introduced. The study was completed with axial and linear scans. RESULTS: The mean examination duration was 31 minutes. Only two patients found the examination annoying because of partial anorectal stricture. The wall layers and their thickness were clearly located and distinguished. Gray-scale US showed the local anatomy in all patients. In 4 patients it depicted the primary fistula as a thin hypoecoic line (40%, three intersphinteric and one transphinteric). Color Doppler US detected the fistula in all patients (100%, seven intersphinteric and three transphinteric). Moreover it showed 2 small secondary tracts in 2 patients. No abscesses were found at the time of the examination. In the patients who underwent a second operation, surgical findings showed a good correlation (90-100%) with color Doppler findings. DISCUSSION AND CONCLUSIONS: This study demonstrated a greater diagnostic value of endosonography with color Doppler and saline solution injection as compared to conventional gray-scale endosonography in the evaluation of fistulae. Since this technique is also cost-effective and well tolerated by most patients we conclude that at present it makes an important diagnostic tool in the preoperative assessment of perianal fistulae.

426 cases of stage I endometrial carcinoma: a clinicopathological analysis.

Between February 1, 1965, and December 31, 1985, 426 patients affected with Stage I adenocarcinoma of the endometrium were submitted to surgery in the Department of Gynecologic Oncology of the Regina Elena Cancer Institute. The value of the present survey is represented by the homogeneous diagnostic data on the basis of which the treatment was planned. Criteria of histological grading and myometrial invasion were always followed, making it possible to carry out a protocol combining surgery with radiotherapy, chemotherapy, and/or hormone therapy. In fact, an accurate evaluation of the grading, the infiltration of the myometrium, and the localization and size of the lesion are necessary to establish the risk of lymph node invasion. This last parameter is the most important as far as the therapeutic protocol, recurrences, and/or metastases and survival are concerned. The high 5-year survival rate, despite the high average age of the patients (74.7% between the ages of 51 and 70), associated pathologies, and the relatively low incidence of complications from treatment, demonstrate the validity of the protocol adopted.