Biomedical subjects
Publications and source records attributed to T Avataneo.
We report the magnetic resonance imaging of a severe, but fully reversible, vertebral osteopenia, due to bone marrow hyperplasia, occurring in a patient with chronic hepatitis C treated with the interferon-alpha/ribavirin combination.
The purpose of this study was to evaluate the topography, morphology and contrast enhancement of the intramedullary metastases (IM) from extra-CNS neoplasms. We report the results of a multicenter retrospective study on 18 patients with 26 IM examined with a 0.5T MR imaging system; intravenous injection of Gd-DTPA was performed in all cases. We found that the lesions are most frequently single, oval shaped, and small, with little or no deformation of the spinal cord (14 of 26 IM). They appear isointense on spin-echo T1-weighted images (24 of 26 IM), with a homogeneous and generally nodular high contrast enhancement after Gd-DTPA injection (21 of 26 IM), and present on T2- and proton-density-weighted sequences with a pronounced perilesional, pencil-shaped hyperintensity of the surrounding cord which is more evident in the cranial part of the cord referring to the IM.
The aim of this study was to verify the persistence in adulthood of GH deficiency diagnosed in childhood and treated with hGH in childhood and to study whether anatomical hypothalamic-pituitary alterations evaluated by magnetic resonance (MR) imaging could predict it. To this goal, in six GHD adults (3 males and 3 females aged 17.2-24.5 yr, BMI 21.8 +/- 1.3), we studied anterior pituitary hormone response to GHRH (1 microgram/kg iv)+pyridostigmine (120 mg po)+ GnRH (100 micrograms iv) +TRH (400 micrograms iv)+hCRH (100 micrograms iv) as well as brain MR imaging. In childhood, the diagnosis of severe isolated GHD had been done based on auxological findings as well as on GH response < 7 micrograms/L after two classical provocative stimuli. In the present study, hormonal responses showed the persistence of severe isolated GHD in 4 out of 6 patients (peak, mean +/- SEM: 3.8 +/- 0.6, range 2.6-4.8 micrograms/L). In these patients, IGF-I levels were found low or low-normal. In other 2 patients, a clear GH response to stimulation (peak: 51.3 and 43.0 micrograms/L, respectively) together with normal IGF-I levels were found. No other anterior pituitary hormone deficiency was present in all subjects. MR imaging showed pituitary hypoplasia in all patients with persistent GHD; in 2 out of them, pituitary stalk interruption and ectopic neurohypophysis was also present. On the other hand, MR imaging showed normal hypothalamo-pituitary morphology in the 2 subjects with normal somatotrope response. In conclusion, our present data indicate that testing with a potent stimulus such as GHRH+pyridostigmine is a reliable method to assess the persistence of GH deficiency which associates with anatomical hypothalamic-pituitary alterations at the MR imaging. Patients with transient GH deficiency in childhood and normal pituitary GH reserve in adulthood have normal hypothalamic-pituitary MR imaging.
OBJECTIVE: A new long-acting injectable form of bromocriptine has become available for long-term treatment of hyperprolactinaemic patients. The objective of this study was to compare efficacy and tolerability of injectable and oral forms of bromocriptine. DESIGN: A double-blind randomized study. All patients received either one injection of bromocriptine 50 mg intramuscularly and placebo tablets for 28 days (Group A) or one placebo injection and oral bromocriptine 7.5 mg daily for 28 days (Group B). PATIENTS: Twenty-three (12 patients for Group A and 11 patients for Group B) hyperprolactinaemia patients with (19 patients) or without (4 patients) CT/MRI evidence of tumour were studied. MEASUREMENTS: Plasma PRL levels and serum bromocriptine levels were assessed during a follow-up of 42 days. MRI and/or CT were evaluated before and 28 days after the beginning of the study. RESULTS: All patients had significant reductions of PRL levels from 1000 h and 1100 h of day 1 to 2000 h of day 35. Normoprolactinaemia was shown in eight patients of Group A and six of Group B on days 1-28. Normal PRL levels were still present in five patients of Group A and in one patient of Group B on day 35; only three patients of Group A had normoprolactinaemia on day 42. A significantly greater decrease in Group A in comparison with Group B was shown at 1200 h on day 1 and at all times as a percentage decrease from basal levels. Significantly higher levels of bromocriptine were shown in Group A at all timepoints studied. No difference was shown in tolerability and incidence of side-effects. CONCLUSION: Our data show that injectable bromocriptine more frequently induced a prolonged normoprolactinaemia than did the oral drug. Moreover, bromocriptine levels released during injectable bromocriptine were significantly higher than during oral bromocriptine. On the other hand no difference was shown in the tolerability of bromocriptine according to the route of administration.
Nineteen acromegalic patients (12 females and 7 males, aged 24-71 yr) were studied for 1-6 yr after radiotherapy (RT), administered by X-rays (18 MeV) by linear accelerator, with parallel opposite beams (doses 45-50.4 Gy, 1.8 Gy daily). Basal GH levels gradually decreased from 6.3-76.2 micrograms/L (mean +/- SE, 27.8 +/- 4.9) to 0.3-43.4 micrograms/L (11.7 +/- 3.6 micrograms/L; p < 0.005) at the last assessment. The earliest significant decrease was observed after one yr (14.9 +/- 3.8 micrograms/L; p < 0.005). Significant changes were observed also in IGF-I values (basal values 1.93-6.85 mU/ml, 3.22 +/- 0.30; last assessment 0.55-4.57 mU/mL, 1.58 +/- 0.31; p < 0.01). The earliest significant decrease of IGF-I values was observed after 2 yr (1.61 +/- 0.16 mU/ml; p < 0.005). GH levels < 5 micrograms/L together with normal IGF-I values were observed in 9 patients, 2-4 yr after RT. No changes were observed in PRL values, either in patients with pretreatment normal or elevated PRL levels. The CT and/or MRI picture of macroadenoma disappeared after 6-12 months in 3/12 patients. Moreover, a reduction (20-55%) in the diameter of the adenoma was shown after 6-36 months in other 4 patients. After RT 5/16 (31%) patients required cortisol and 4/19 (21%) thyroid replacement therapy. In 2/3 men a gonadal impairment was shown, that did not occur in the three female patients with normal gonadal function before RT.(ABSTRACT TRUNCATED AT 250 WORDS)
Magnetic resonance imaging was performed in 23 patients with short stature (7 had multiple pituitary hormone defect, 11 had isolated growth hormone deficiency and 5 had normal variant short stature) to investigate if there is a relation between magnetic resonance findings and results of endocrine tests. Magnetic resonance imaging of patients with multiple pituitary hormone deficiency or with serious isolated growth hormone deficiency (growth hormone < 3 micrograms/l) revealed an interrupted pituitary stalk and ectopic neurohypophysis or a mass. In patients with less serious isolated growth hormone deficiency (growth hormone > 3 micrograms/l) or with normal variant short stature, the technique revealed a normal or hypoplastic hypophysis. Magnetic resonance appears to be a useful second-level diagnostic tool in defining the type of alteration in growth defects of endocrine origin.
The efficacy and tolerability of a long term treatment (21-53 months; mean, 36) with a new injectable form of bromocriptine (Parlodel LAR, Sandoz) was assessed in 13 patients (9 males and 4 females, aged 14-68 yr) with macroprolactinoma. Parlodel LAR was administered deeply im once monthly, with 50 mg as the first dose. Depending on the patient's tolerability to the drug and the PRL levels, the dose was individually progressively increased to 100 mg (2 patients), 150 mg (3 patients), or 250 mg (4 patients). Persistently normal PRL levels were recorded in 4 patients even after the first injection and in 5 other patients treated with higher doses of Parlodel LAR (2 patients with 100 mg/month; 3 patients with 150 mg/month). The remaining 4 patients who were treated with 250 mg/month had a marked reduction of PRL levels (72-94%), but did not reach normalization. Two patients treated with 150 mg/month maintained normoprolactinemia in spite of subsequent dose reduction of Parlodel LAR to 50-100 mg/month. In 1 patient PRL plasma concentrations remained within normal range for 3 months after the transitory discontinuation of Parlodel LAR at the end of the first year of therapy. Regular menses were resumed in 1 of 3, and galactorrhea disappeared in 2 of 3 women. All male patients had a return of libido and potency; gynecomastia disappeared in both male patients, and galactorrhea disappeared in 1 of 2 male patients. Visual fields improved in all 5 patients; complete normalization occurred in 2 of them. A consistent shrinkage of the macroadenoma (23-100%) at different times after therapy was shown by magnetic resonance imaging and/or computed tomography in 12 of 13 patients. Six patients reported mild/moderate side-effects (nausea, vomiting, orthostatic hypotension, or dizziness) within 24 h after the first injection. In 2 of these patients, mild side-effects persisted for 1-2 days after the first 3-6 injections, and in one patient, mild nausea was reported after each injection. In conclusion, in patients with macroprolactinoma, Parlodel LAR is an effective and well tolerated preparation of bromocriptine when administered once a month.
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A new long-acting repeatable injectable form of bromocriptine, (Parlodel LAR, Sandoz, Basle, Switzerland) has recently been developed. We studied the clinical, hormonal and radiological changes in six female patients with microprolactinomas and eight (3 female and 5 male) with macroprolactinomas receiving monthly injections of Parlodel LAR 50 to 100 mg for 6 months. Five patients with microadenomas and 4 with macroadenomas had normal prolactin (PRL) levels with Parlodel LAR 50 mg after one (5 patients), two (2 patients), or five (2 patients) injections; two patients with macroadenomas had normal or near normal PRL levels only after 4 monthly injections of 100 mg. Clinical improvement paralleled the changes in serum PRL. A complete normalization of a visual field defect occurred in one patient after 5 months of therapy. Marked shrinkage of the adenoma was shown by magnetic resonance and/or computed tomographical imaging in three patients with macroadenomas after 1 week. Side-effects were mild and usually transient. Parlodel LAR represents a novel treatment of hyperprolactinemic states which is both effective and well tolerated, and appears to be a useful alternative to oral therapy for long-term treatment.
The CT, surgical and histological findings were examined of 350 lymph nodes in a perspective study of 50 patients affected with lung cancer. CT accuracy could thus be evaluated in assessing the size of hilar and mediastinal lymph nodes; the incidence of histologically-proven metastases in nodes more/less than 10 cm in diameter could also be determined, together with CT diagnostic accuracy for nodal metastases. Finally, CT capabilities were also evaluated in distinguishing N0 from N1-N2 patients. CT proved to have high negative predictive value and low positive predictive value, which caused the authors to raise the normal threshold value of CT evaluation of the greatest diameter for hilo-mediastinal nodes from 10 to 20 mm.
The authors discuss the possible role of Magnetic Resonance Imaging (MRI) in the follow-up of renal transplants. Its diagnostic accuracy is compared with Ultrasounds (US), which is considered the method of choice in postoperative monitoring of renal transplants. Thirty-two patients (transplant life ranging from 5 days to 37 months) were examined in the same day with both MRI and US. Sonographic evaluation is based on a group of signs related to renal alterations and unanimously ascertained; the identification of MR patterns of normally functioning kidney or renal rejection might give way to more extensive clinical applications of the method, with the advantages of multiplanarity and no X-ray use. MR diagnostic accuracy in the diagnosis of normally functioning transplant or renal rejection was 82.7% (vs. US: 68.9%); even though specificity was the same (84.6%). MRI had higher sensibility than US (82.25% vs. 656.25%). MRI is more sensitive in demonstrating renal pathology in transplanted kidneys, and its diagnostic accuracy is superior. Still, US must be considered the methodology of choice in instrumental research when there is a clinical suspicion of renal rejection, due to its sufficient diagnostic accuracy, to its being easy to perform in continuous follow-up, to its low cost and to the short execution time. MRI is nevertheless suggested in the follow-up of renal transplants both in questionable cases and when biopsy cannot be performed.
CT can be considered the most reliable technique in detecting nodal metastases of the cervical district. The Authors have studied 170 patients with laryngeal cancer (104 N0, 21 N1, 21 N2 and 24 N3 clinically) with CT of the cervical region during infusion of contrast material. All patients underwent radical neck dissection with pathological examination of the nodes. CT diagnosis and pathological findings were correlated. Our findings show that CT has an overall accuracy of 91.8% (100% in groups N2 and N3) and fed false positives and false negatives.
Twenty-five patients affected by adrenal glands pathology underwent CT and MRI: 6 non-functioning adenomas, 2 Cushing's adenomas, 2 Conn's adenomas, 6 metastases, 3 cysts, 2 carcinomas (Cushing's syndrome), 1 lymphoma and 3 pheochromocytomas. Diagnosis was subsequently confirmed either at surgery, or autopsy, or with needle biopsy. In all cases normal adrenal glands and pathological lesions were showed by MRI. T1 signal intensity and mass diameter were compared with T2 signal intensity, represented by the intensity ratio between the adrenal mass vs normal hepatic parenchyma. MRI signal intensity, usually high in case of malignancy and low in adenomas, shows a mean value which is much wider than that referred to mass diameter evaluation (carcinoma is larger than adenoma); for this reason those findings have proved to be insufficiently accurate for adrenal tissue characterization, even for the evaluation of cysts and pheochromocytomas. In the same cases CT showed higher accuracy.
Current usage of MR in the clinical study of adrenal pathology is assessed with a review of the advantages and limitations of this new imaging technique and a critical analysis of data deriving both from the literature and from personal experience. The possibility of a multiplanar study offered by MR permits a more accurate anatomical-topographical definition of the adrenal masses though it is not yet capable of the tissue characterisation that would diagnose the nature of the lesion, though it can differentiate between inert adenomas and metastases.
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The diagnostic reliability of CT in pheochromocytoma was evaluated in 12 symptomatic and 2 asymptomatic patients with a total of 1 bladder and 15 adrenal histologically confirmed tumours. Particular attention is drawn to two cases with bilateral sites (one male child, one woman with Sipple's syndrome) and the detection of possible local and distant malignancy. CT is thus an examination of the first order, since it is noninvasive, specific (no false positives) and able to reveal even small tumours.
A comparison was made between the adrenal or hypophyseal histology and the CT finding of adrenal glands in 18 Cushing patients in an assessment of CT as a preliminary screening measure prior to hormone studies for the detection of subjects with adrenal tumours, and hence candidates for adrenalectomy. The CT finding were: 8 tumours (7 adenomas and 1 carcinoma), 5 hyperplasia, 5 NAD. All the adrenal tumours (diameter 18-69 mm) were correctly identified. The only distinctive feature of the carcinoma was its size. A CT diagnosis of adrenal tumour can be regarded as conclusive. Pictures indicative of hyperplasia or absence of alterations, however, must be supplemented by hormone tests and (if necessary) CT of the hypophysis.