5-HT1-receptor agonist sumatriptan modifies gastric size after 500 ml of water in dyspeptic patients and normal subjects.

Sumatriptan, a 5-HT1-receptor agonist has been shown to delay gastric emptying of liquids and solids in humans. However, no data are available of the effect of sumatriptan on gastric adaptation after distension with liquids and on symptoms induced by gastric distension. In 23 normal subjects and 30 dyspeptic patients with normal upper gastrointestinal endoscopy and real-time ultrasonography, the transverse gastric proximal and distal area and sagittal axis of the proximal stomach were determined by real-time ultrasonography and computed tomography after 500 ml of water. The area was determined by real-time ultrasonography and computed tomography twice at times 48 hr apart. Thirty minutes before real-time ultrasonography, placebo or sumatriptam were give subcutaneously in a double-blind fashion. Epigastric pain, bloating, heartburn, and nausea were also monitored through an intensity score from zero to 10 performed during the test. In six dyspeptic patients, the gastric distension was performed also with real-time ultrasonography and computed tomography after placebo and hyoscine butyl-bromide, a quaternary anticholinergic agent. Real-time ultrasonography and computed tomography demonstrated that after sumatriptan there is a reduction in proximal and distal transverse area and an increase in the sagittal axis of the proximal stomach. Hyoscine butyl-bromide increased all gastric measurements. Among the symptoms evaluated, only nausea was significantly reduced by sumatriptan (P < 0.01). Sumatriptan modifies gastric size, with a reduction in the transverse section and an increase of the sagittal axis of the proximal stomach and improves the nausea induced by gastric distension in dyspeptic patients.

[Intra-arterial infusion of PGE1 alpha cyclodextrin]. / Infusione intra-arteriosa di PGE1 alpha-ciclodestrina.

BACKGROUND: Intra-arterial infusion of PGE1 alpha-ciclodestrina was achieved by intrafemoral catheter in critical limb ischemia. METHODS: The acute infusion of 10 micrograms in 20 minutes, in 50 ml of saline was followed by chronic infusion 20 micrograms/die of PGE1 alpha-ciclodestrina for 5 days. Three male patients (age 65 +/- 12) with severe critical ischemia and rest pain with initial, localised (> 0.5 cm in diameter) necrosis were treated. There was no possibility of revascularisation in these patient. RESULTS: No side effects due to the intra-arterial infusion were observed. After the acute infusion skin flux (measured with laser Doppler at the dorsum of the foot) was increased on average 15.2 times (P < 0.01). The increase in flux was still present 10 days after the initial intra-arterial infusion. Pain was greatly decreased or disappeared in the three following 3 weeks. CONCLUSION: In conclusion, even on the basis of limited clinical data, intra-arterial infusion acutely improves skin perfusion in critical limb ischemia. It could be considered a fast acting treatment in critical ischemia and also a rapid method to evaluate the possibility of improving distal perfusion with PGE1 alpha-ciclodestrina (i.e. patients not responding to intra-arterial infusion could be considered for amputation).

Ultrasonic classification of carotid plaques causing less than 60% stenosis according to ultrasound morphology and events.

Carotid plaque morphology studied by ultrasound has been used to classify 3 types of bifurcation plaques, producing less than 60% stenosis on duplex scanning: Type A, the homogeneous, highly echogenic plaque; Type B, the heterogeneous (mainly echogenic, B-1 or mainly echolucent, B-2) plaque; Type C, the complex plaque with irregular surface, echogenic and/or echolucent with calcifications. One hundred asymptomatic subjects in each plaque group were included in a prospective 4-year follow-up study to evaluate clinical events and brain damage by yearly cerebral CT and MR scans. After four years 96 subjects with type A plaque, 89 with type B-1 and 67 with type C plaques completed the study. While there were no clinical events or positive cerebral scans in subjects with type A plaques there was a significantly increasing number of cerebral and vascular events in subjects with plaque B and C type with a zero mortality in the plaque A group, a 2.24% mortality in type B plaques and a significantly higher (p > 0.05) mortality (13.4%) in type C plaques. CT and MR scans revealed brain damage which had been totally asymptomatic with MR detecting a larger number of lesions. Also the number of cerebral lesions observed by CT/MR were significantly greater than the number of recorded clinical episodes. ECG stress test revealed a larger number of asymptomatic coronary disease in the C type plaques. In conclusion ultrasound plaque morphology is linked to different incidences of cerebral and cardiac events, brain damage and asymptomatic coronary disease. Also CT and MR may reveal lesions which do not cause signs or symptoms.

[Magnetic resonance in the assessment of critical points of impingement of the shoulder]. / La risonanza magnetica nella valutazione dei punti critici di attrito della spalla.

Impingement syndrome is caused by a conflictual status between rotator cuff, subacromial bursa and anatomic and functional acro-mioclavicular arch. The clinical signs of this syndrome include pain and functional disability in abduction and extrarotation of the shoulder. This study was aimed at verifying Magnetic Resonance Imaging (MRI) capabilities in showing the critical points of impingement and their incidence. Fifty-four cases of impingement syndrome were studied. The best visualization of functional acromioclavicular arch was obtained using a new study technique. All patients had critical points of impingement. In 65% of cases, acromioclavicular arthritis induced impingement on the supraspinatus tendon and in 35% of cases on the muscle. In 46% of the patients, impingement between coracoacromial ligament, partially thickened in 25% of the cases and totally thickened in 75%, and supraspinatus tendon was observed. In 7% of the whole of shoulders, the acromion had an uncinatus shape. MRI, thanks to its multiplanar imaging, allowed the complete evaluation of the articular structures with complex anatomy. The assessment of different types of impingement points can be considered a valuable approach to the therapeutic stage.

Talocalcaneal coalition: computed tomography and magnetic resonance imaging diagnosis.

A correct evaluation of site and extension of the talocalcaneal coalition inducing biomechanical ankle alterations is very important for planning therapy. Four male patients were submitted to computed tomography (CT) and three of them were also examined by means of magnetic resonance imaging (MRI). In one patient, studied by CT only, a bilateral talocalcaneal coalition was present, while the other three patients, controlled with CT and MRI, were affected by monolateral talocalcaneal coalition which was of osseous type in one case and fibrocartilaginous in two cases. CT and MRI provided detailed information on type and extension of the coalition and both helped in distinguishing between osseous and fibrocartilaginous forms. Only MRI showed an area of subchondral ischemic disease of the posterior subtalar joint in one patient with monolateral fibrocartilaginous talocalcaneal coalition. Compared with CT, MRI proved to be more accurate in evaluation of the talocalcaneal coalition, due to its wider display capability.

[Magnetic resonance in the staging of multiple myeloma]. / La risonanza Magnetica nella stadiazione del mieloma multiplo.

The authors retrospectively reviewed the MR examinations of 46 patients with clinical and laboratory findings of monoclonal gammopathies (MG). All cases had been submitted to radiographic examination which had shown skeletal involvement in 22 cases and osteoporosis in 11, with rupture of the vertebral body in 3 patients. Scintigraphy had been performed on all patients and CT on 12; 36 patients were subsequently submitted to follow-up (at 6, 12 and 24 months). MR examinations were performed with dedicated coils and standard sequences for the subjects with skeletal localizations on X-ray images. The extant cases, with no radiographic evidence of skeletal involvement, were submitted to MRI of the spine, skull and pelvis. In agreement with clinical and laboratory findings and with follow-up results (in 36 patients), MRI diagnosed MG with no skeletal involvement in 13 cases, osteoporosis in 8 (with rupture of the vertebral body in 2), asymptomatic non-progressive myeloma in 4, solitary myeloma in 3, and multiple myeloma in 18 cases. The good identification of bone marrow and its multiplanarity make MRI the method of choice in the study of patients with suspected or known gammopathies. If compared with other modalities, MRI is more sensitive and accurate in depicting the tumor, its size and relationship to periskeletal tissues, and its possible multifocality. Moreover, the technique has proven to be a valid tool during the follow-up, showing tumor response to therapy.

[Acute instability of the shoulder in athletes. The role of magnetic resonance in therapy planning]. / Instabilità acuta della spalla negli atleti. Ruolo della risonanza magnetica nella pianificazione terapeutica.

Magnetic resonance imaging (MRI) of the shoulder was performed to evaluate both the actual role of this technique in the study and staging of acute shoulder instability, and its potentials as diagnostic tool, with particular reference to treatment planning. Seventeen athletes with acute shoulder instability were examined. All MRI examinations, subsequent to plain radiographs, were performed within 48 hours from the traumatic event. After MRI examination, 14 patients underwent physiotherapy (2 cases were subsequently submitted to arthrotomy), and only 3 cases underwent surgical treatment in the acute phase (2 arthrotomies and 1 arthroscopy). These cases, submitted to MRI in the acute phase and subsequently to surgery, showed anterior glenoid labrum involvement with good evidence of associated skeletal lesions (Hill-Sachs lesions in 1); changes in the inferior glenohumeral ligament complex (2 cases) were also observed. In the other examined cases, MRI always provided accurate information on the glenoid labra and the anterior capsular mechanism. When the superior glenohumeral ligament was investigated (9 cases of 17), no alterations were observed. Acting as natural contrast, the presence of joint effusion allows good visualization, on T1-weighted sequences, of the structures involved by the traumatic events. Contrast resolution improvement could be obtained by employing gradient-echo T2 weighted sequences, which proved to be quite valuable for a correct depiction of the lesions involving the inferior glenohumeral ligament complex. In conclusion, MRI can be considered as a valuable diagnostic method for the early evaluation of the acute shoulder instability, since it provides information of the utmost importance for the subsequent therapeutical approach.

Production processes of recombinant IL-1 beta from Bacillus subtilis: comparison between intracellular and exocellular expression.

The human IL-1 beta coding sequence derived from a cDNA library was inserted into two different plasmid expression vectors, pSM214 and pSM308, which promote the synthesis of recombinant products intracellularly and exocellularly, respectively. The hybrid constructs pSM261 and pSM320 were obtained. Bacillus subtilis SMS118 was transformed with these plasmids and the recombinant strains were grown in 1 litre bioreactors. Different growth conditions were analyzed to optimize yields both in terms of biomass and IL-1 beta production. In the pSM261-harbouring strain, IL-1 beta was synthesized in the cytoplasm to levels ranging from 1 to 2.7 mg g-1 of cells, corresponding to up to 40 mg l-1 of the culture. In contrast, SMS118(pSM320) was able to secrete 0.27 mg of natural IL-1 beta per g of cells (6.7 mg l-1 of culture). Processes for the purification of IL-1 beta from the supernatant and the biomass of the two cultures were also developed and compared in terms of yield and simplicity of the purification schemes. From our data it turns out that the route of intracellular expression is very efficient and superior to the one which results in secretion of IL-1 beta. This indicates that the use of B. subtilis as a recombinant host in biotechnology is not strictly dependent on its ability to secrete proteins into the culture medium.

The diagnostic value of magnetic resonance in disc pathology of the lumbosacral region.

An MRI tomograph was used to examine 396 patients with suspected disc pathology of the lumbosacral region. Forty two patients in whom disc herniation was diagnosed underwent surgery. MR proved to be a reliable and accurate method for the diagnosis of disc herniation, revealing its site and size as well as compression on the neural structures. The limits of MR are discussed and integrated diagnostic protocol in lumbosacral disc pathology is proposed.

[Magnetic resonance of the shoulder: technic, anatomy ana clinical results]. / Risonaza magnetica della spalla: tecnica, anatomia e risultati clinici.

MR imaging was employed in 232 patients with traumatic or degenerative lesions of the shoulder. MR diagnosis was compared with arthrotomic findings in 19 cases, and with arthroscopic results in 3 cases. MR technique is here presented and the choice of scanning planes is discussed, together with the sequences of image acquisition and with the features of the surface coil employed. Axial, sagittal, and coronal scans were used in all cases. Both sagittal and coronal planes were performed obliquely on the basis of precise anatomical structures. T1-weighted sequences were used for they are reliable in locating the various anatomical structures and efficient in defining the several different pathologic conditions. The role of T2-weighted sequences was complementary, and they were employed in selected cases only. A surface coil is presented with a particular configuration of easy clinical use and with such technical features as to allow reduced fields to be imaged, with good spatial resolution. MR imaging could demonstrate with equal accuracy both skeletal-cartilage components and capsulo-ligamentous structures, thus defining associated lesions and small tears. In both degenerative and traumatic lesions of the rotator cuff, MR imaging showed both extent and entity of the pathologic process, with high accuracy in defining the impingement syndrome. MR imaging allowed the depiction of the anterior and posterior glenoid labra, even without intraarticular contrast media. Moreover, MR imaging made it possible to recognize both fractures and degenerative processes within the glenoid labrum on the basis of their signal intensities. This preliminary experience allows the authors to conclude that MR imaging is an accurate and non-invasive diagnostic method for the study of traumatic lesions and of degenerative changes of the shoulder.

[Soft-tissue sarcomas of the extremities. Their assessment with magnetic resonance]. / Sarcomi dei tessuti molli delle estremità. Valutazione con risonanza magnetica.

MR imaging was performed on 38 patients with suspected malignant soft-tissue tumors of the extremities. MR diagnostic accuracy was compared with that of other methods. All patients underwent surgical control. In 7 cases MR imaging was employed to demonstrate the tumor response to antiblastic local perfusion. Lesion identification, extension, compartmental evaluation, bone and vascular involvement were the diagnostic parameters considered. In all cases MR imaging detected the lesion, correctly showing the intracompartmental (16 patients) or extracompartmental (22 patients) extension. In 2 out of 6 cases MR imaging did not demonstrate bone invasion, and in 1 case vascular involvement could not be assessed. MR diagnostic accuracy was superior to that of other techniques. Nonetheless, a diagnostic protocol was proposed for the local staging of malignant soft-tissue tumors of the extremities where some diagnostic limitations of MR imaging are taken into account--i.e., inconsistent evaluation of bone and vascular involvement. Plain X-rays and US are the imaging modalities of choice, whereas MR imaging is to be a second-choice diagnostic technique before biopsy. Thus, MR imaging replaces CT, while angiography is to be used in selected cases, where MR imaging is not diagnostic due to vascular involvement.

[Osteosarcoma. A new diagnostic approach in presurgical loco-regional staging]. / Osteosarcomi. Nuovo approccio diagnostico nello staging loco-regionale pre-chirurgico.

The value of Magnetic Resonance (MR) imaging was examined in the anatomical staging of bone osteosarcomas. Eleven patients were studied--8 central and 3 parosteal osteosarcomas. The accuracy of MR imaging was compared to that of plain film, scintigraphy, CT, and angiography. MR imaging was superior to both CT and radionuclide scanning in defining intramedullary extension and in showing skip metastases. Cortical erosion in central osteosarcomas was demonstrated by MR imaging, CT, and plain film; in 1 case of parosteal osteosarcoma MR imaging was superior to CT in showing cortical penetration. In two cases MR imaging did not accurately demonstrate the relationship of the tumor to the major vessels; only angiography showed vascular involvement. MR imaging was useful in delineating extraosseous extension. The importance is stressed of a correct use of MR imaging towards an accurate diagnosis. In fact, intramedullary extension and skip metastases were better demonstrated on T1-weighted images with large fields, while T2-weighted images and small fields were needed for the best overall evaluation of extraosseous involvement. In conclusion, MR imaging should be used for preoperative staging of osteosarcomas in those cases where diagnosis was made on the basis of clinical, radiographic, and bioptic findings.

Prosthetic reconstruction of the anterior cruciate ligament of the knee: the roles of CT scan and M.R.

The authors examined 10 patients treated by intra-articular reconstruction of the anterior cruciate ligament with an artificial ligament in terylene (Kejo-Leeds type). Clinical evaluation was supplemented by CT scan and magnetic nuclear resonance (M.R.). The basic parameters assessed were the positioning of the tunnels, biological anchoring, presence of reactive synovitis, growth and modification of periligamentous fibrous tissue, characteristics and relationships of the extra-articular plastic. CT scan was better at determining the tunnels, evaluating biological anchoring and visualising the new ligament in its intra-articular course. Magnetic nuclear resonance was better at evaluating changes in the periligamentous tissue. The authors therefore conclude that M.R. is preferable in the early follow-ups, while CT scanning has greater diagnostic value in follow-ups after six months.

[Role of magnetic resonance in the radiologic diagnosis of parotid pathology]. / Ruolo della risonanza magnetica nella diagnostica radiologica della patologia parotidea.

MRI findings in 13 patients with monolateral parotid tumor were compared with US, sialographic and CT findings. MRI did not allow an accurate diagnosis in 2 patients with diffuse chronic parotitis. MRI was superior to CT in 1 case in defining the intraglandular site of the lesion, and in 2 patients in showing the extraglandular involvement. MRI proved to be superior to CT thanks to its contrast resolution and to multiplanar imaging. MRI high contrast resolution made it possible to demonstrate neoplastic lesions of 4 mm in diameter. The lesion has low signal intensity on T1-weighted images and high signal intensity on T2-weighted. Parotid tumors cannot be characterized by signal intensity alone: only morphology allows to discriminate between benign and malignant lesions. To conclude, US is a screening method, while MRI is helpful in detecting multifocal lesions and in evaluating the tumor extent.

[Chondrosarcoma of the bone. Differential pre- and postoperative diagnosis using magnetic resonance]. / Condrosarcomi dello scheletro. Diagnostica differenziale pre- e post-operatoria con Risonanza Magnetica.

Twelve patients were studied by means of Magnetic Resonance Imaging (MRI) in order to demonstrate either loco-regional recurrence of central chondrosarcomas or degenerative evolutions of exostoses. MRI findings were compared with plain film, scintigraphy, and Computed Tomography. MRI showed loco-regional recurrences by demonstrating their site, extent, and relationship with adjacent structures. In showing the degenerative evolution of exostoses MRI--confirmed at surgery--was superior to plain film in 3 cases out of 7, and to Computed Tomography in 2 cases. The authors discuss MRI findings: chondrosarcomas have low-intensity signal in T1-weighted sequences and high-intensity signal in T2-weighted. Thanks to its high contrast resolution MRI always allowed the detection of the chondrosarcoma. Nevertheless, MRI did not allow the tumor grading--which is due either to a difficult evaluation of the morphology of neoplastic calcifications, or to non-specific-intensity signal.

Polypeptide fraction from bovine factor VIII does not influence human platelet aggregation and blood coagulation.

It is well known that high molecular weight bovine factor VIII is able to aggregate human platelets and possesses procoagulant activities. There is also growing body of evidence that the hydrolysis of bovine factor VIII abolishes its aggregating and coagulative properties. We have shown in this paper that a polypeptide fraction (molecular weight 1000-25000 daltons) from bovine factor VIII does not aggregate platelets nor affect blood coagulation. In this study we investigate the action of the polypeptide fraction derived from bovine factor VIII and suggest that its effect may occur only at endothelium level without an involvement of platelets as well as blood coagulation.

[Comparing computerized tomography and magnetic resonance in the study of articular pathology of the knee]. / Raffronto TC e RM nello studio della patologia articolare del ginocchio.

The authors present a comparison between the diagnostic accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) in the articular pathologies of the knee. CT and MRI were performed in 30 patients who subsequently underwent surgery. CT and MRI results were compared on three bases: technique, definition of normal anatomy, and diagnostic accuracy. CT allowed a standardization of the technique, while MRI was superior in defining normal anatomy--especially in the study of capsulo-ligamentous structures. In all cases the use of both CT and MRI allowed a correct diagnosis, showing the site, extent and gravity of the lesion. CT proved to be superior to MRI in 4 cases, while MRI corrected CT diagnosis in 11 cases; in 15 patients both techniques had the same diagnostic accuracy. Meniscal tears were better identified by CT, while MRI was superior in the detection of ligamentous lesions and in the characterization of PVNS and tendinitis of the patellar tendon. In conclusion, MRI should be performed in selected cases only, or when CT cannot be trusted; on the other hand, it might also be used as a first-choice diagnostic procedure for synovial pathologies and acute lesions of the anterior cruciate ligament.

[Role of magnetic resonance in the staging and post-chemotherapeutic follow-up of malignant maxillo-facial tumors]. / Ruolo della risonanza magnetica (RM) nello staging e nel follow-up post-chemioterapico dei tumori maligni maxillo-facciali.

Ten patients with squamous cell carcinomas located in the maxillo-facial region were studied. In all cases the staging by Computed Tomography (CT) and Magnetic Resonance (MRI) revealed metastatic lesions in stage T3-T4. All patients underwent polichemotherapy before surgery. MRI proved to be more accurate in the staging of tumors in 3 cases only, while in 7 cases both techniques showed the same diagnostic accuracy. In the follow-up, MRI allowed the evaluation of the effect of chemotherapy on the carcinomas: it demonstrated the regression and necrosis of 9 tumors out of 10 (the patients could undergo surgery), and the progression of the tumor in 1 case. The study of bioptic specimens demonstrated the lack of correlation between histological grading of the tumors with MRI signal intensity and T1, T2 relaxation time, as measured by spectroscopy.

[Reflex sympathetic dystrophy syndrome. Contribution of magnetic resonance]. / Sindrome distrofica simpatico riflessa (RSDS). Contributo della risonanza magnetica.

An attempt was made to establish Magnetic Resonance Imaging (MRI) diagnostic criteria for the study of the reflex sympathetic dystrophy syndrome (RSDS). Five patients with hip and knee pain were studied. The radiographic pattern was "positive" only in two patients, while radionuclide studies showed increased activity in the painful joint in all; only in three cases Computed Tomography was performed. In all patients MRI demonstrates the lesions and defines their extension. MRI allows a differential diagnosis between RSDS and other bone lesions such as osteonecrosis and tumors. The relation between anatomopathological findings of RSDS and MRI features is discussed. MRI proved to be a reliable technique in showing and characterizing RSDS better than radiographic examination (often "negative" in early phases), and radionuclide study (a sensitive but not specific technique).