[Magnetic resonance in the assessment of perianal fistula]. / La Risonanza Magnetica nella valutazione delle fistole perianali.

This study was aimed at investigating the effectiveness of Magnetic Resonance Imaging (MRI) in the diagnosis of perianal fistulas, by comparing imaging findings with those provided by rectal examination (RE) or surgery. The present data refer to 20 patients with anorectal fistulas in whom 24 main fistulous tracks were found. The fistulas were classified according to Parks and Kennedy's criteria, based on their relationship to the sphincters. In the 15 surgical patients, 15 of 17 fistulas were correctly identified by MRI (88.2%). In one case the submucous path of the fistula was missed, while another patient was misdiagnosed as having an intersphincter fistula which turned out to be a transphincter one at surgery. In the 5 non-surgical patients, only 4 of 7 MR-detected tracks were identified at RE. An intersphincter fistula was missed on rectal examination but demonstrated by both MRI and endoscopy. A suprasphincter track in a patient who was initially asymptomatic and thereafter developed a perianal abscess, was missed at clinics but became apparent on MR images. In one case anorectal examination underestimated the extent of the fistulous track, which was thought to be low while MRI demonstrated it to be high. Twelve abscesses were seen on MR images, all of them classified at surgery. One posterior pararectal suppurative collection in a non-surgical patient was apparent only at MRI. In our experience, in agreement with the latest literature reports, MRI has proved to be a very reliable method in the assessment of anorectal inflammatory diseases. We believe that MRI may play a valuable role in the preoperative assessment of the complex conditions causing a high risk of recurrence or anal incontinence as a result of inadequate treatment.

[The prevalence of diffuse and focal lesions of the hepatic parenchyma in a nonselected, resident population. A prospective echographic study]. / Prevalenza delle lesioni diffuse e focali del parenchima epatico in uná popolazione residente, non selezionata. Studio prospettico ecografico.

A group of 2978 randomly chosen residents from a rural area of Veneto (Italian region), aged 18-69 years, was assumed as a study population. They underwent US examination of the liver, routine liver function tests, and--when necessary--other imaging techniques and liver biopsy. Liver US exam detected diffuse lesions in 26% of cases (mostly bright liver pattern), and focal lesions in 3%; US findings were normal in 66% of patients and questionable or inconclusive in 5%. As far as focal lesions were concerned, the final diagnosis was angioma (24 cases), cyst (31), neoplasm (5). When bright liver pattern was observed, liver function tests were altered in 78% of the patients; when US findings were normal, liver function tests were normal in 59% of cases. In conclusion our data: 1) show that focal and diffuse liver abnormalities are relatively frequent in unselected and asymptomatic people, 2) confirm US diagnostic utility, and 3) suggest that US be employed as a screening exam in study populations.

[Renal parenchymal neoplasm as a chance finding during hepatobiliary echography]. / La neoplasia renale parenchimale come reperto occasionale durante ecografia epato-biliare.

Renal cell carcinomas are often diagnosed as incidental findings during abdominal US or CT carried out for extra-urological reasons. In order to ascertain the incidence of renal carcinoma two groups of patients were considered: a) 2400 outpatients who had undergone hepato-biliary US for routine screening; b) 1330 inpatients who had undergone US, for non-urological purposes, which had been systematically extended to the kidneys. Two cases of renal cell carcinoma (PT1) were found in group A. Four cases were found in group B--2 of them were stage PT1, and 2 were PT3. These results show how a certain number of unsuspected and early-stage renal cell carcinomas can be diagnosed by US, even when the examination is not intended as a renal study. On the basis of the above observations, we suggest that US be performed in all upper abdomen examinations. At any rate, right kidney US seems to us mandatory when hepatobiliary US is performed.

[Echography with portable equipment. Its possibilities and limits in the hepatobiliary area]. / Ecografia con apparecchi portatili. Possibilità e limiti nella regione epato-biliare.

Ultrasound examination of the liver by simple low-cost equipment (LCUS) is currently performed. In order to evaluate the accuracy of this imaging technique in the detection of liver diseases, 150 outpatients were examined with a LCUS unit. The same patients were then re-examined with more sophisticated equipment (SEUS) in a department of radiology. The images thus obtained were compared to the previous ones: LCUS appears to be a valuable screening method, even though several US features--i.e. hyperechogenicity of the liver, focal hypoechoic lesions, and microlithiasis--are better demonstrated by more sophisticated units.

[Internal echography. Problems inherent in iconographic documentation and reporting. A proposal for codification]. / Ecografia internistica. Problematiche inerenti la documentazione iconografica e la refertazione. Proposta di codificazione.

Problems concerning iconographic documentation and reporting in abdominal ultrasound are discussed. The authors propose schemes for a minimal iconographic documentation of the various organs and systems in case of negative examinations or to be associated with the documentation of the lesion in pathologic cases. Afterwards more complex questions in reporting are discussed, concerning dimensions of organs, echostructure and terminology in use with the proposal of a standard pattern. The authors point out how codification and standardization both of images and report are by now necessary in echography, in order to make examinations more comparable and capable of being evaluated.

[Radiological and echographic aspects of milk of calcium bile]. / Aspetti radiologici ed ecografici della bile calcarea.

In a series of 17 patients with milk of calcium bile radiologically examined, 9 underwent even ultrasound. A constant sonographic pattern was not observed, and an explanation for this finding is attempted. Ultrasound is not considered a suitable procedure for identifying this pathology, and it should be associated with plain x-ray examination.

Gas-containing gallstones: their influence on ultrasound images.

The ultrasound image of gas-containing gallstones was evaluated in three cases. In two, the stones were studied in vitro in a phantom gallbladder by ultrasound, and then by microradiographic techniques. The third case was investigated in vivo by ultrasound and computerized tomography (CT). The presence of gas-containing fissures, which are not detectable on ultrasound, was demonstrated. In contrast, wider fissures, or a true gas bubble, produce reverberation echoes which depend upon the quantity of gas present within the gallstone.

[Liver metastases with posterior acoustic shadow in echography: causes and differential diagnosis]. / Metastasi epatiche con ombra acustica posteriore all'ecografia: cause e diagnosi differenziale.

Seven cases of metastases with acoustic shadow have been detected in a series of 108 liver metastases. In two cases this echographic pattern corresponded to calcified metastases and in one case to a necrotic metastasis, containing gas. In the last four cases the presence of an acoustic shadow (all colon carcinoma metastases in chemotherapy) must be attributed to the tissue characteristics of the lesion, since neither calcifications nor gas could be shown by CT. A possible effect of chemotherapy in causing this type of image can be thought to exist; this, according to the finding of hypoechogenic metastases turning to the same above mentioned pattern following chemotherapy.

[Ecographic studies of 72 aneurysms of the abdominal aorta (author's transl)]. / Studio ecografico di 72 aneurismi dell'aorta addominale.

The authors, studying 72 abdominal aortic aneurysms by ultrasounds, show the main diagnostic problems of this pathology. These aneurysms are divided into two classes: the silent and the acute ones; the second group includes the atherosclerotic aneurysms in rupture and the dissecting aneurysms. Ecography is considered as a preliminar test in the evaluation of the aneurysms of the first group, allowing, in case of good results, the surgical operation without other invasive tests. Ultrasounds can also reduce problems of differential diagnosis. In case of non dissecting acute aneurysms, ecography leads to a quick diagnosis, allowing sudden surgery. In case of dissecting aneurysms, angiography remains the best examination, except those rare cases with atypical symptoms.

The stenosis of the terminal esophagus after surgical repair of the hiatus hernia.

Eighty-two operations of hiatus hernia repair were performed at the General Surgery Department of the University of Padua from 1966 to 1975. Two cases of iatrogenic stenosis of the the terminal esophagus, whose correction required postoperative dilatations, occurred in this series. This complication should be separated from the transient dysphagia frequent occurring, without radiologia or endoscopic evidence of esophageal lesions, after hiatus hernia repair. The stenosis followed two different repair techniques but, at present time, it is impossible to establish a relationship between occurrence of the iatrogenic lesion and repair techniques used. Eventhough iatrogenic stenosis of the terminal esophagus does not occur frequently, it is a possible complication to keep in mind while performing hiatus hernia repair, because it is exclusively related to defects of the surgical technique.

[Transillumination of the breast]. / La transilluminazione della mammella.

The physical basis of the method, the procedure, the normal and pathological findings are described. On a series of 125 pathology cases observed, transillumination proved useful as a diagnostic aid in breast diseases.