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P Ercolani

Publications and source records attributed to P Ercolani.

At least 19 recordsLinked to original sources
PubMed2003

Aldosterone synthase alleles and cardiovascular phenotype in young adults.

The C(-344)T promoter polymorphism of the human aldosterone synthase (CYP11B2) gene has been associated with hypertension and cardiac hypertrophy, but there were contrasting data. We analysed the genotype/phenotype associations between this polymorphism and cardiovascular variables in a young adult population, where interactions among genes, gene-environment, and acquired ageing-related organ damage are reduced. Anthropometric measurements, blood pressure, heart rate, left ventricular variables (by echocardiography), and carotid artery wall intimal-media thickness (by high-resolution sonography and digitalized morphometry) were taken in 420 white Caucasian students (mean age 23.5 years, s.d. 2.5 years). CYP11B2 alleles were detected by genomic polymerase chain reaction followed by digestion. Taking into account the three possible models of inheritance, we found no differences in the considered variables, except for an independent effect of the C(-344) allele on SBP in males (TT 125.6 (1.6), TC 128.4 (1.2) and CC 130.5 (2.2), mmHg, media (ES), P=0.03), and on interventricular septum thickness in diastole in females (CC 6.98 (0.12) vs TT 6.87 (0.09) and TC 6.87 (0.07), mmHg, P<0.01), in the codominant model. In conclusion, the CYP11B2 C(-344)T polymorphism appears to have a slight role in the cardiovascular phenotype of young healthy adults, even if these genotype/phenotype relationships might change with ageing.

Adult↗
PubMed2001

Tendon involvement in rheumatoid arthritis of the wrist: MRI findings.

OBJECTIVE: To evaluate the distribution and extent of wrist tendon alterations in patients with active rheumatoid arthritis (RA) using magnetic resonance imaging (MRI). DESIGN AND PATIENTS: Forty-three clinically active RA patients with an illness duration of less than 4 years and no clinical evidence of tendons tears were enrolled in the study. There were 10 men and 33 women, with an average age of 52 years (range 33-63 years). MRI of both wrists, with one exception, was performed at 1.0 T using T1- and T2-weighted sequences (slice thickness 3 mm). Twelve healthy subjects (8 women, 4 men; mean age 31 years) were also evaluated as a control group. Two radiologists reviewed each of four schematic anatomical regions (volar, dorsal, ulnar, radial) for the degree of tendon and tendon sheath alterations using two progressive scales. RESULTS: In the control group all tendons had homogeneous low signal intensity on all sequences. A small amount of fluid was found in six subjects but the diameter was always less than 1 mm. In the patient group minimal fluid (< 2 mm) was found in 35 (41%) wrists, grade 2 fluid (< 2 > 5 mm) in 26 (31%) and grade 3 fluid (> 5 mm) in 24 (28%). Fifty-nine (69%) of the grade 1 changes were in the volar compartment but grade 2 involvement was evenly distributed. Grade 3 changes were most common in the dorsal compartment and combined grade 2 and 3 in the dorsal and ulnar compartments were 32 (38%) and 25 (30%) compared with 16 (18%) and 17 (20%) respectively in the volar and radial compartments. The tendons were normal (grade 0) in 47 (46%) wrists. A maximum tendon signal change (grade 1) was demonstrated in 28 wrists (32%). When associated with other individual tendons grades this grade was demonstrated in the dorsal compartment in 30 (35%) wrists, in the volar compartment in 12 (14%), in the radial compartment in 17 (20%) and in the ulnar compartment in 26 (30%). A partial tear (grade 2) was detected in 7 (8%) wrists, all involving the dorsal and ulnar compartments; five underwent surgical repair and one proved to have a complete rupture of extensor digitorum. Three (3%) had a grade 3 complete tendon tear: all of these were in extensor tendons. Surgical repair was successful in one case but two ruptured again within 3 months. CONCLUSIONS: Low grades of peritendinous effusion were more common in the volar compartment whereas moderate and high degrees of tendon sheath fluid collection and/or pannus and signs of tendonitis were more frequent in the dorsal and ulnar tendon sheaths.

Arthritis, Rheumatoid↗
PubMed2001

Cardiovascular phenotype of young adults and angiotensinogen alleles.

OBJECTIVES AND DESIGN: Angiotensinogen (AGT) gene variants influence angiotensinogen plasma levels in children and young adults. The angiotensinogen promoter (-6)A variant facilitates gene transcription in human tissues and it has been associated with high blood pressure in older adults. A young adult population can be used as a model to study genotype/phenotype associations between AGT (-6) variants and cardiovascular variables. METHODS AND RESULTS: Anthropometric measurements, blood pressure and heart rate were taken in 422 white Caucasian students (mean age 23.5 years, SD 2.5 years). Family history for hypertension, physical activity and smoking history were evaluated. Left ventricular variables were measured by echocardiography. Carotid artery wall intimal-media thickness (IMT) was measured by high resolution sonography and digitalized morphometry. The AGT G(-6)A alleles were evaluated by mutagenically separated polymerase chain reaction controlled by direct sequencing. No significant associations were found between angiotensinogen genotype and blood pressure, cardiac variables [except for deceleration time in females which increased with the number of (-6)A alleles] and IMT. Allele frequencies were similar between the first and third tertile of blood pressure and left ventricular mass, and were also similar between negative or positive family history for hypertension (the last group having significantly higher systolic blood pressure in males, P = 0.04 and diastolic blood pressure in females, P < 0.01). Moreover, no relevant interaction on the cardiovascular variables was found between AGT genotype and body mass index. CONCLUSIONS: The angiotensinogen G(-6)A variants do not affect cardiovascular parameters in young adults, but an effect of this polymorphism on cardiovascular phenotype (and hypertension) in older adults cannot be excluded. Additional factors, associated with ageing, should be present to unleash the supposed unfavourable potential of the (-6)A angiotensinogen variant.

Adult↗
PubMed1998

Dynamic MRI of the breast.

OBJECTIVE: To describe the rationale, the technical requirements and the examination technique of dynamic magnetic resonance studies of the breast and to assess the role of this method in the clinical diagnostic protocol. MATERIAL AND METHODS: We reviewed the relative literature and compared the results with our personal experience. RESULTS: The earliest reports on the possibility of differentiating carcinoma from benign tissue with magnetic resonance imaging came from Germany, where in 1986 Heywang and coworkers used T1-weighted spin-echo sequences before and after i.v. Gd-DTPA administration with an imaging time of approximately 5 mins and 5 mm slice thickness. With advances in magnetic resonance technology, Heywang Koebrunner adopted a static three-dimensional fast low-angle shot technique permitting < 3 mins' imaging time and providing high resolution with thin slices. This approach may detect even the carcinoma which occasionally does not enhance in the typical rapid, intense way. A review of 400 biopsy-proved lesions showed that all carcinomas enhanced strongly, all but 5% rapidly and 85% focally. Over 70% of benign masses exhibited no major contrast uptake, although some benign tumors and proliferative dysplasias enhanced strongly. At present, Heywang-Koebrunner use rapid three-dimensional gradient-echo sequences (TR/TE 14/7, FA 25 degrees; at 1.0 T) which have the advantages of three-dimensional imaging and permit dynamic studies (< 1 min/sequence). The same sequence is used at our institution. The dynamic technique is advocated by Kaiser who in 1989 reported preliminary sensistivity and specificity values over 95%. The time/signal intensity curves revealed the rapid and strong enhancement of malignancies, the gradual and strong enhancement of the only fibroadenoma studied, and the gradual and mild contrast uptake of benign dysplasia. In 1992, in nearly 1000 dynamic examinations, Kaiser and Reiser reported 98.3% sensitivity, 97.0% specificity, 82.1% predictive value and 97.2% accuracy. The combination of rapid acquisition with techniques that preserve high spatial resolution may improve specificity by allowing the study of lesion morphology as well as of enhancement patterns. A whole-breast imaging technique has been reported which permits acquisition times < 15 s by partial sampling of the central k-space region superimposed on high-resolution three-dimensional images. CONCLUSIONS: Dynamic magnetic resonance imaging of the breast is currently an important step of the clinical protocol of breast diseases, but there is no established study protocol yet.

Breast Neoplasms↗
PubMed1995

[Magnetic resonance arthrography in chondral disease of the knee].

The clinical usefulness of Magnetic Resonance Imaging (MRI) of the knee in the depiction of meniscal, ligament and tendon lesions is well known. In contrast, the role MRI plays in the diagnosis of chondromalacia remains debated, the gold standard being arthroscopy. A new technique, i.e., MR arthrography (MRA), has been recently proposed which consists of the intraarticular injection of a paramagnetic contrast agent (Gd-DTPA) during MRI. Thirty-one patients with clinically suspected chondromalacia of the knee were examined with MRA. The exams were performed with a 1T superconductive magnet and a dedicated coil. All the patients were examined before (baseline scans) and after paramagnetic contrast agent injection. MRA results were compared with arthrographic findings. Baseline MRI had 25% sensitivity, 77.9% specificity and 83% diagnostic confidence in the diagnosis of chondromalacia; these figures increased to 93%, 97.6% and 91.5% after contrast agent injection. This preliminary experience confirms MRA to be a useful tool in the diagnosis of chondral knee conditions.

Adult↗
PubMed1994

MR imaging of hepatic masses: diagnostic significance of wedge-shaped areas of increased signal intensity surrounding the lesion.

OBJECTIVE: Wedge-shaped areas of increased signal intensity surrounding focal hepatic lesions on T2-weighted images have been described as an occasional finding in patients with hepatic metastases. We reviewed MR images of patients with benign and malignant focal hepatic lesions to determine the prevalence and diagnostic significance of this finding, and in particular to determine if these wedge-shaped areas are characteristic of cancer. MATERIALS AND METHODS: One hundred twenty-one patients with focal hepatic lesions (65 patients with metastases, 14 patients with hepatocellular carcinoma, and 42 patients with benign conditions) underwent MR imaging of the liver at 1.0 T. Axial spin-echo T1-weighted and spin-echo and turbo spin-echo T2-weighted MR images were obtained. The MR images were retrospectively evaluated: the number and size of the lesions and the presence of wedge-shaped areas surrounding the lesions were recorded; in patients with cancer, follow-up MR images and a clinical course were used to study the evolution of the lesions and the adjacent wedge-shaped areas. The final diagnosis in patients with cancer was proved by clinical course (54 patients) or fine-needle aspiration biopsy (25 patients); in patients with benign lesions, the findings on various other imaging techniques were accepted as conclusive. RESULTS: The wedge-shaped areas were noted on T2-weighted images in 16 (25%) of 65 patients with metastases, in 3 (21%) of 14 patients with hepatocellular carcinoma, and in 5 (12%) of 42 patients with benign lesions. In 11 of the 16 patients with metastases and wedge-shaped areas of increased signal intensity, a metastatic lesion within the wedge-shaped area was detectable; in the remaining five patients, a metastatic lesion appeared during the subsequent clinical course. In some instances, the wedge-shaped area obscured the lesion. In patients with benign conditions, the wedge-shaped area was frequently seen in association with hemangiomas (4 of 13, 31%). CONCLUSION: Our results show that wedge-shaped areas of increased signal intensity surrounding lesions on T2-weighted MR images are a common finding in patients with focal hepatic lesions. The wedge-shaped areas cannot be considered pathognomonic of malignant lesions because they are also seen in patients with benign conditions (hemangioma, abscess). However, the appearance of these wedge-shaped areas in a patient with cancer should suggest a metastasis. The possibility that hepatic lesions could be obscured by these wedge-shaped areas also should be considered when response to treatment is being evaluated.

Adult↗
PubMed1994

[Turbo-Spin-Echo sequences in focal liver diseases].

Turbo Spin-Echo (Turbo SE) pulse sequences represent a new type of fast sequences characterized by a dramatic reduction in acquisition time with similar intrinsic contrast to that of conventional Spin-Echo (SE) pulse sequences. For a preliminary clinical comparison of turbo SE and SE sequences, a consecutive series of 25 patients with focal liver lesions was investigated by means of MRI at 1.0 T. The patients were selected on the basis of US or CT positive liver scans for focal lesions. All patients underwent MRI following the same protocol: axial T1-weighted (T1W) gradient echo (GE) sequences (TR/TE = 110/6 ms) with the "breath-hold" technique, T2-weighted (T2W) SE sequences (TR/TE = 1730/90 ms; FL = 60, M = 128 x 256, 2 AC, TA = 7 min 26 sec) and turbo SE sequences (TR/TE = 5100/112 ms, M = 240 x 256, 2 AC, TA = 2 min 48 sec). Slice thickness was 10 mm with a 1-mm gap in all cases. Qualitative (number, size and definition of the lesions) and quantitative (contrast-to-noise ratio (CNR) and relative CNR) variables were considered. SE and turbo SE sequences demonstrated the same number of lesions; the smallest lesion (3 mm) was identified by turbo SE sequences. Turbo SE sequences better depicted lesion margins than SE sequences. In all cystic conditions, CNR was higher in turbo SE than in SE sequences, while it was lower in all the extant conditions. This preliminary experience proves turbo SE pulse sequences to be a valuable tool in liver MRI, which calls for further clinical trials.

Adult↗
PubMed1993

Ultracytochemical localization of particulate guanylate cyclase in rat adrenal gland exposed to stimulation by porcine brain natriuretic peptide.

We studied the cytochemical localization of particulate guanylate cyclase (GC) in rat adrenal gland after stimulation with porcine brain natriuretic peptide (pBNP) by electron microscopy. In the adrenal cortex, GC activity, as demonstrated by the presence of reaction product, was prevalently localized to the zona glomerulosa and zona fasciculata, while the zona reticularis showed little GC reaction product. In the adrenal medulla, GC reaction product was present only in adrenalin-containing cells. All GC positivity was associated with intracellular membranes. No GC reaction product was detected in specimens incubated in media devoid of pBNP. In parallel samples incubated in the presence of rat atrial natriuretic factor (rANF), the distribution of rANF-stimulated GC activity was similar to that of pBNP-stimulated GC activity.

Adrenal Cortex↗
PubMed1993

Inadequacy of ultrasonography for monitoring response to treatment of liver metastases.

PURPOSE: We prospectively evaluated the clinical efficacy of ultrasonography (US) in monitoring the effect of medical treatment in patients with liver metastases, by comparing serial US assessment with serial magnetic resonance imaging (MRI) evaluation and clinical outcome in a group of 41 patients with solid tumors. PATIENTS AND METHODS: Both examinations were performed in patients with metastatic liver disease at the start of a new treatment modality and monthly thereafter for 3 months; close monitoring was prolonged beyond the third month in cases in which there was disagreement between the two techniques and the clinical course was not conclusive. RESULTS: Planned follow-up was completed in 37 cases. There was limited concordance between the two examinations: in 21 cases only (56.8%), US and MRI gave concordant information on the evolution of hepatic metastases; in eight cases, both agreed on progression of disease (PD), in 11 cases on stable disease (SD), and in one case each on partial response (PR) and complete response (CR). In the remaining 16 cases (43.2%), there was disagreement between the two examinations. On the basis of subsequent clinical course, this discrepancy was shown to be due to US inadequacy in 13 cases and to MRI inadequacy in one case; in two cases, the clinical course was not conclusive. The most striking limits of US appeared to be twofold: (1) a progressive appearance, with chemotherapy, of a diffusely inhomogeneous structure of the liver, resulting in obscuration of focal lesions (and a subsequent judgement of CR) in cases in which lesions were, on the contrary, detected at MRI and usually confirmed by subsequent clinical course; and (2) false US-determined PD in cases in which lesions proven at baseline MRI were noted at US only after one to two courses of therapy. CONCLUSION: We conclude that US, which is known to be inaccurate for screening of liver metastases, is unreliable for the follow-up of metastatic liver disease; despite its wide availability, low cost, and noninvasiveness, critical therapeutic decisions should not be made based on the outcome of this test.

Adult↗
PubMed1992

MR imaging in the diagnosis of carpal tunnel syndrome.

Diagnosis of carpal tunnel syndrome (CTS) is usually made on the basis of clinical and electrophysiologic data. Other tests, however, such as ultrasound and CT, have enabled us to acquire additional information regarding the anatomical definition of the structures inside the carpal tunnel. The superior quality of MRIs soft-tissue definition led us to employ it in cases of median nerve compression at the wrist in order to determine its true diagnostic value. We compared the preoperative electrophysiologic and MRI findings in 23 cases of CTS which had undergone surgical decompression of the median nerve at the wrist. Exact correspondence with the intraoperative findings confirmed the reliability of the anatomical information provided by MRI, yet the same comparison revealed that correct "functional" information could be provided only by the electrophysiologic tests.

Adult↗
PubMed1991

[Dynamic imaging with magnetic resonance in the diagnosis of breast disease].

MR imaging was employed for the identification and tissue characterization of nodular lesions in the breast. The study had poor outcome, but the clinical introduction of a paramagnetic contrast medium, Gd-DTPA, allowed better results to be obtained. This study was aimed at evaluating the possibilities of Gd-DTPA enhanced MRI in differentiating benign from malignant breast nodules and in staging cancer. Final diagnosis was made by means of either histology, in the patients who underwent surgery, or cytology. Sixty-one patients with nodules at mammography and US were examined with MRI. The results of US, mammography, and MRI were blindly evaluated and proved that combined mammography and US, together with Gd-DTPA enhanced MRI, correctly identified all nodular lesions. Moreover, enhanced MRI allowed benign lesions to be distinguished from malignant nodules. MRI with Gd-DTPA correctly assessed both T parameter and pectoral muscle infiltration. MRI cannot replace mammography, which is a quick and inexpensive examination, but it should be performed as an adjunct in the cases of questionable radiographic and US findings and to stage breast cancer.

Adult↗
PubMed1991

[Magnetic resonance of the rheumatoid hand].

The purpose of this study was to evaluate MRI diagnostic accuracy in rheumatoid arthritis (RA), to compare MRI and radiological findings and to correlate these findings with the clinical and serological profile of the disease. The hands of 24 patients (20 females, 4 males) affected with typical RA (ARA criteria) were studied using a tomograph Magnetom 1.0 T Siemens. Two patients affected with RA refractory to conventional second-line drugs who received a bolus of methylprednisolone (1 g) were studied before and after such treatment. The hands of healthy volunteers were examined as controls. Besides MRI study all patients underwent: (1) radiological examination of the hands performed with a standard technique and (2) clinical and serological investigation aimed at characterizing diseases activity and extent. The radiographic and MRI findings were evaluated by two different observers who found 15 pathological elementary lesions and assigned a MRI and a radiological score to each patient. MRI exhibited significantly higher accuracy than radiography in evaluating rheumatoid soft-tissue changes and in detecting minimal skeletal lesions, while severe skeletal lesions were better detected by radiology. No correlation was found between pathological MRI findings, radiological results and clinical or serological data. A significant drop in soft-tissue effusion was observed after methylprednisolone pulse in two patients. This study confirms MRI potential in the study of rheumatoid joint lesions and in the early detection of minimal soft-tissue changes. Its use appears to be suitable for accurate monitoring of RA patients under specific therapy.

Adult↗
PubMed1991

[Psychologic reactions of patients undergoing magnetic resonance imaging. Preliminary study].

MR imaging, like other imaging techniques, can cause emotional and psychological reactions in the patients. Although reversible, these reactions sometimes lead the patient to absolutely refuse the examination or to make it impossible to carry it through. To investigate the patients' emotional distress, a study group of 28 subjects was examined. They were heterogeneous in sex, age, and pathologic condition. The main psychological reactions were analyzed, and anxiety--both of state and of trait. The anxiety parameter was evaluated as a specific index in the psycho-behavioral modifications induced by MR examination. The influence was also considered of the "fantasies" related to examination results on the patients' psyche. Talks and STAI X1 and STAI X2 were employed to this purpose, to identify possible disturbing elements related to both patients' character and examination situations. Our results point to anxiety as the major reaction observed in the subjects undergoing MR examination; it seems to be related to different parameters, which are difficult to identify. Claustrophobia, pathofobia, and the fear of an unknown examination play a major role. Talking to the patients and informing them of the characteristics of the examination proved useful to significantly reduce their emotional distress.

Adolescent↗
PubMed1990

[The clinical utility of stereotaxic x-ray guided cytological biopsy in nonpalpable neoplastic pathology of the breast].

The authors report the initial results of the combined use of stereotaxic X-rays and fine-needle aspiration biopsy in 83 patients with nonpalpable breast lesions. The stereotaxic system employed is a simple accessory of conventional mammographic equipment. Cytologic diagnosis (94 biopsies) had 90% sensitivity and 97% specificity; the percentage of acellular/insufficient cytologic samples was 10.8%. To assess the clinical value of this technique, the obtained results were compared with both mammographic findings and US-guided aspiration biopsy data.

Biopsy, Needle↗
PubMed1990

[Magnetic resonance in the staging of bladder neoplasms: results of the use of JKA1, a ferrous contrast solution].

The authors report the results of the staging of urinary bladder cancers by means of MRI using a new ferrous contrastographic solution called JKA1. Eighteen patients with proved bladder neoplasms were examined by means of MRI: the bladder was filled with physiological solution first, and then with JKA1. Six patients were studied also after filling their bladders with Gd-DTPA solution (1:50). The results show that the use of JKA1, a T2-positive contrast medium, improved MR capabilities in the evaluation of small lesions (phi less than 1 cm) with minimal invasion of bladder wall; MR staging accuracy was 66.6% with the physiological solution and 77.8% with JKA1. The authors confirm the need for a wider MR study, in particular of T2 lesions (a critical subject for staging and surgical management) to assess MR diagnostic capabilities.

Aged↗
PubMed1990

[Two mammographic periods compared].

The authors report the results obtained in two different series of cases examined by means of mammography in 1968/74 and in 1987/89. All patients had histologically proven breast cancer. The first series of cases included 183 patients who were examined with a mammographic unit with fixed anode, 0.6 x 0.6 mm focal spot, and 25-40 cm FFD. The second series included 152 patients who were examined with a last-generation mammographic unit with turning anode, 0.3 x 0.3 mm focal spot, 50-65 cm FFD, and radiographic magnification. Lesion staging in the first group went as follows: 10% of patients were T1, and 90% were in more advanced stages; in the second series, 42% were T1 and 52% were in more advanced stages. Mammographic accuracy was 83% in the first series and 84.8% in the second series. The main mammographic features of the lesions and their incidence were analyzed. In 11 patients examined with a last-generation unit, breast cancer was diagnosed for the presence of indirect signs which had not been demonstrated with the older unit. In conclusion, last-generation mammographic units allow an earlier diagnosis to be made, and most signs of breast cancer to be promptly demonstrated.

Breast Neoplasms↗
PubMed1989

[Role of ultrasonics in the diagnosis of subclinical carcinoma of the breast].

The authors report the results of a retrospective multicentric study concerning the sonographic diagnosis of subclinical breast cancer, 11,254 patients were examined by means of mammography, with last-generation mammographic equipment, and by means of real-time US with 7.5-10 MHz transducer. Fifty-seven subclinical breast cancers were identified and histologically confirmed. US detected 30/57 neoplastic lesions, versus mammography 47/57; in particular, US identified 10 cancers missed at mammography, while the latter detected 27 malignant lesions missed at US. Mammographic accuracy in the early detection of breast cancers was 82.4%, while US accuracy was 52.6%. Mammographic false negatives were due to opacity of the glandular parenchyma. US false negatives presented at mammography as microcalcifications (67%), lesions less than 1 cm phi (22%), and indirect signs (11%). The results of this study demonstrate the important role of US in women with radiographically-dense parenchymal patterns, but confirm the superiority of mammography in the detection of subclinical breast cancer.

Biopsy↗