[Intestinal preparation with an osmotic solution for edema with double contrast media]. / Preparazione intestinale con soluzione osmotica per il clisma con doppio mezzo di contrasto.

PURPOSE: To evaluate the most effective way of cleansing the colon lumen for double contrast colon enema with a single preparation at osmotic effect. MATERIAL AND METHODS: We examined 80 patients (age range: 29-84 years) and divided them into two groups. Group 1: patients (no. 41) were prepared with the traditional method consisting of a residue-free diet in the three days before the examination followed by the administration of a sennoside-based laxative the morning of the day before and a dose of magnesium sulphate in the afternoon, after the Genoa School method. Group 2: patients (no. 39) were prepared with a Phospholax solution according to the following administration schedule: one dose in the evening two days before the examination and four doses the day before, that is two in the afternoon and two in the evening, followed by abundant hydratation. The examination was performed in a double blind fashion and graded as follows: excellent, good, sufficient, poor. The statistical analysis of all data was performed with Student's t-test and the chi-square test. RESULTS: We obtained better results with the new protocol than with the traditional one, where some patients discontinued the preparation because of intolerance (nausea, abdominal pain and swelling). In addition, more fecal residues were found in the colon with the first preparation, which however provided better contrast agent coating than the new protocol. The second preparation provided better mucosal cleansing, with more cases graded as excellent-good, and there were no cases of poor coating or electrolyte disturbances. DISCUSSION AND CONCLUSIONS: Intestinal preparation with Phospholax was better than the conventional method relative to compliance, intestinal cleansing and side-effects (in both the latter two cases, the difference is statistically significant, p < 0.01). In conclusion the new protocol is a possible alternative to the traditional method thanks to its ease of preparation and effective results.

[Subacute Budd-Chiari syndrome treated with rTPA. Considerations on a case]. / Sindrome di Budd-Chiari subacuta trattata con rTPA. Considerazioni a proposito di un caso.

The authors report on a case of hepatic vein thrombosis or Budd-Chiari syndrome (BCS) successfully treated with recombinant Tissue Plasminogen Activator (rTPA). They briefly outline the etiology and symptomatology of this disease as well as the various surgical procedures used for treatment. Medical therapy has been so far poorly effective in treatment BCS, but recently various reports seem to indicate that rTPA may have a role. The authors suggest that rTPA may be used as the only therapy in selected cases, or in treating patients that are not candidates for surgical intervention, or as a temporizing measure to improve symptoms in patients awaiting surgery.

[Echographic study of the shoulder. Clinico-echographic correlations]. / Esame ecografico della spalla. Correlazioni clinico-ecografiche.

US is indicated in the study of the impingement syndrome. A series of 152 shoulders was examined in a clinical-US study carried out following a standard protocol including a physical examination first and then a US examination. The study was aimed at investigating the agreement between clinical and US findings and at assessing the diagnostic reliability of US. 57% of the shoulders were positive to clinics (1 test at least) and were then divided in 4 groups. Positivity rate was high (85-87% for at least 3 or 4 tests). US findings included several different patterns. Our results demonstrate that a correct clinical-diagnostic protocol increases reliability, besides reducing the use of more complex and expensive imaging modalities--e.g., CT and MR.

[Diagnostic considerations in a case of pericardial effusion with anomalous distribution]. / Considerazioni diagnostiche su di un caso di idropericardio a distribuzione anomala.

The authors report an atypical arrangement of pericardial effusion simulating an expansive mediastinal mass. Radiologic examination of the chest (standard, fluoroscopy and conventional tomography) failed to establish the correct diagnosis, its diagnostic aid was only related to demonstrate the lesion, without provided any additional anatomical and morphological features. The final and correct diagnosis was only obtained with CT and U.S. These latter imaging modalities have correctly located the lesion in pericardial space, and particularly they identified it like an loculated, completely fluid pericardial not corpusculated effusion. The authors remarked the value of CT and US techniques in the study of para and pericardial regions, especially of pericardial serosal surfaces. CT scan allow to localize the lesion, and to discriminate through densitometric values between cystic and solid masses; further more it provided information of possible extracardiac and/or mediastinal invasion. US provides the features of the fluid, its changes during systo-diastolic cycle, its mobility in different patient positions and the thickness of cardial wall. Nevertheless, at present, we consider both imaging modalities indispensable in the study of lesions occupying the cardiac-mediastinal border.

[The nephrotoxicity of ionic and nonionic contrast media in urography. An evaluation with immunoenzyme technics and monoclonal antibodies]. / Nefrotossicità da mezzi di contrasto ionici e non ionici in urografia. Valutazione con tecniche immunoenzimatiche e anticorpi monoclonali.

The nephrotoxicity of ionic and nonionic contrast media (cm) was evaluated in 52 patients undergoing pyelography. The contrast media were i.v. injected in 30'. Urine samples were collected before, 2 and 48 hours after the injection. Urinary albumin (alb) and retinol binding protein (RBP) excretion was evaluated by immunoenzymatic methods; alb and RBP were considered as indicators of glomerular permeability and of tubular reabsorption, respectively. The urinary excretion of brush-border antigen of proximal tubule (BBA) was also measured, as an indicator of microtissue damage, by a sensitive double-antibody ELISA with monoclonal antibodies. The results demonstrate ionic cm to have greater functional effects than nonionic ones, as suggested by the increased urinary excretion of both alb and RBP. However, tubular damage seemed to be more severe with nonionic agents, as suggested by BBA excretion. Although toxic damage had little significance for the patients' health, long-term effects are not to be excluded.

[Computerized tomography in pulmonary sequestration]. / Studio T.C. nel sequestro polmonare.

The authors describe two cases of intra and extralobar pulmonary sequestration and evaluate its principal clinical and pathological characteristics. They outline the key role of T.C. in the approach to this pathology. The T.C. enables to collect in a short time a large quantity of useful information for a correct diagnosis which could not be obtained by means of other methods of imaging.

[CT in the evaluation of the extension of bronchogenic carcinoma]. / La T.C. nella valutazione dell'estensione del carcinoma broncogeno.

The computed tomographic patterns in 52 patients with histologically proven lung cancer are reported. The AA. underline the not sobstitutive role of C.T. scan in pre-operative determination of bronchogenic carcinoma extension. C.T. revealed a very high diagnostic accuracy in assessing the primary tumor extension and in evaluating distant macrometastases; however, in showing hilar and mediastinal nodal involvement has not the same accuracy. The AA. think that, at the present time, a combinate C.T. study of the chest, upper abdomen and brain is, in the most number of cases, a rapid, accurate and practical method to evaluate the extension of lung cancer.