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PubMedDate not supplied

Regarding six cases of mesenteric panniculitis: US, spiral CT, Magnetic Resonance.

PURPOSE: Mesenteric panniculitis is a rare inflammatory disease. The inflammation produces a lesion which appears as a mass, and normally produces abdominal pain without any other significant clinical signs. The radiological pattern is not typical, but the diagnosis is aided by a number of elements which are important to recognise in order to avoid invasive diagnostic methods or therapy. Six cases are presented, all evaluated with sonography, Color-Doppler US, Spiral CT and Magnetic Resonance Imaging (MRI). MATERIALS AND METHODS: We evaluated six patients with negative clinical histories and endoscopic examinations. The patients reported the recent onset of indefinite symptoms and abdominal pain treated at home. Abdominal plain film radiography, performed also in the upright position, was negative in all cases. All the patients underwent abdominal sonography and Colour-Doppler ultrasound. Spiral CT scanning was carried out with 5-mm slice thickness, a pitch of 1.3, and single breath-hold volumetric acquisitions starting 60 s after intravenous injection of iodinated contrast medium. Only in one case, where Crohn's disease was suspected and subsequently not confirmed, did we perform small bowel enema with transparent contrast medium to distend the bowel loops. MR imaging was performed using a medium-field 0.5 T magnet, T1-weighted Fast SE, T2-weighted Fast SE and Fast STIR sequences. We considered: the mass effect of the lesion; the presence of vascular infiltration; the presence of a peripheral pseudocapsule; the presence of perivascular loose tissue proper, having densitometric characteristics distinctive from the remaining fatty tissue of the diseased mesentery. RESULTS: In all cases ultrasound detected only an central abdominal mass. The fatty content of the mass, however, reduced US transmission, preventing the acquisition of more complete information. The color-Doppler US also produced little data, except some isolated colour spots within the mass. In no case did CT directly detect a peripheral pseudocapsule, although it did identify a difference in density between the perivisceral abdominal loose tissue and the mesentery proper, which is hyperdense. The vessels inside the mesentery on no occasion appeared infiltrated. The CT scans were unable to identify differential elements between the perivascular loose tissue and the fatty tissue of the main mass. MRI, on the other hand, enabled the detection of the peripheral pseudocapsule which surrounded the mesenteric mass as a band of tissue with low signal intensity in all the sequences performed. In fast STIR sequences suppression of the fat signal of the mesenteric mass was insufficient, being suppressed only in the adipose tissue surrounding the arterial branches of the mesenteric artery. Four of the six patients underwent exploratory laparotomy. The histological examination of the biopsies revealed a massive inflammatory infiltration of the mesentery, with relatively little involvement of the perivascular adipose tissue. CONCLUSIONS: In mesenteric panniculitis, sonography and spiral-CT are useful in focusing diagnostic attention on the mesentery, but only MRI is capable of providing the information necessary formulating a complete diagnosis of the disease.

Aged↗
PubMed2004

In vivo accumulation of self-assembling dye Congo red in an area marked by specific immune complexes: possible relevance to chemotherapy.

Supramolecular micellar structures have been proposed as carriers in aim-oriented drug transportation to a target marked by specific immune complexes. In this study, the self-assembling dye Congo red was used as a model supramolecular carrier and its accumulation in the target was studied in vivo. The target was created in vivo as the local specific inflammation provoked by subcutaneous injection of antigen to the ear of a previously immunized rabbit. The color caused by accumulation of Congo red after its intravenous injection was registered by pictures of the ear with suitably filtered visible light shining through it to distinguish Congo red against the background color of hemoglobin. The results confirmed the expected accumulation and retention of Congo red in the inflammation area marked by deposits of specific immune complexes. The role of albumin and its possible interference with transportation of drugs through the blood by supramolecular carriers was also subjected to preliminary examination. The results revealed that albumin collaborates rather than interferes with drug transportation; this is another factor making the use of supramolecular carriers for aim-oriented chemotherapy highly promising.

Albumins↗
PubMed2004

[Significance of point of no return in therapeutic strategy for treatment of renal osteodystrophy; from histopathological findings].

Point of no return implies a stage at irreversible to medical treatment of secondary hyperparathyroidism, clinically equivalent to intact PTH levels are more than 500 pg/mL in Japan. Most of glands resected by parathyroidectomy indicate nodular hyperplasia, increased parathyroid cell proliferation. Down-regulation of calcium sensing receptors and vitamin D receptors in nodular parathyroid cells become a cause of resistance to medical treatment. Most of nodular glands are more than 500 mg in weight, predictable to existence at estimated volume and gland color signals by ultrasonographic method. New options both parathyroid injection therapy using ethanol and active vitamin D, and calcimimetic agent have a potential to change point of no return in therapeutic strategy for secondary hyperparathyroidism.

Biomarkers↗
PubMed1990

Use of the pulsed dye laser and ultrasonic lithotriptor for removal of multiple intrahepatic gallstones.

Two established urologic modalities used for removal of kidney stones were applied in a complementary manner for percutaneous transhepatic removal of multiple intrahepatic gallstones. A pulsed dye laser was used through a flexible nephroscope to fragment a large impacted stone. A stone basket was used to remove stone fragments and a few small entrapped stones. Subsequently, an ultrasonic lithotriptor carried by a rigid nephroscope was tried and found to be a much more efficient means of removing the remaining small stones.

Cholelithiasis↗
PubMed2001

Leber hereditary optic neuropathy associated with antiretroviral therapy for human immunodeficiency virus infection.

PURPOSE: Antiretroviral therapy has reduced the morbidity and mortality associated with human immunodeficiency virus (HIV) infection. However, side effects are increasingly recognized, including a commonly reported toxic mitochondrial myopathy. We report such a case of Leber hereditary optic neuropathy in a patient with antiretroviral therapy for HIV infection and speculate on a possible toxic etiologic role in the development of Leber hereditary optic neuropathy by a shared mitochondrial mechanism. METHODS: Case Report. Bilateral optic disk abnormalities observed in a 38-year-old HIV positive man with a family history of Leber hereditary optic neuropathy were documented with fundus photography, color vision testing, and visual field testing. Mitochondrial DNA testing was used to confirm the genetic predisposition to Leber hereditary optic neuropathy. RESULTS: Progressive bilateral optic nerve pallor temporally associated with the administration of antiretroviral medication was observed. Diagnostic testing revealed progressive visual field and color vision loss as well as a mitochondrial DNA mutation consistent with Leber hereditary optic neuropathy. CONCLUSION: Antiretroviral therapy may be associated with the onset of Leber hereditary optic neuropathy in genetically predisposed patients.

Adult↗
PubMed2005

Demonstration of recanalized left coronary artery after thrombolysis by transthoracic echocardiography.

BACKGROUND: Demonstration of recanalized coronary artery is mostly done by angiographic techniques. Early bedside demonstration of reperfusion after thrombolysis by transthoracic echocardiography (TTE) has important implications in the subsequent risk stratification and timing of coronary interventions. METHODS: In this study, 12 patients with acute anterior myocardial infarction who received thrombolytic therapy were studied. Echocardiographic Doppler evaluation of left main coronary artery, proximal left anterior descending coronary artery (LAD), and proximal left circumflex coronary artery were studied before, during, and after thrombolytic therapy. Coronary flow in these arterial segments was assessed both by color flow and velocity measurements. These results were compared with coronary angiographic studies performed within 30 minutes to 48 hours of thrombolysis. RESULTS: Blood flow in left main coronary artery, LAD, and left circumflex coronary artery could be assessed in 9 patients. There was no demonstrable flow in LAD in 6 patients before thrombolysis. In 7 patients flow could be demonstrated in LAD after thrombolysis within 15 minutes to 6 hours. The peak flow velocity in LAD at a localized area of turbulence postthrombolysis varied from 1.8 to 4.5 m/s. One patient showed mosaic color flow in left main coronary artery with a peak velocity of 1.9 m/s before thrombolysis that improved to a laminar flow with a peak velocity of 1.0 m/s after thrombolysis. Two patients showed normal flow in proximal LAD, but no flow in mid-LAD. Two patients did not show any flow in LAD even after 12 hours of thrombolysis. There was good correlation of site of critical narrowing in LAD by TTE with coronary angiography in 6 patients. In 3 patients absent flow in mid-LAD by TTE correlated with total occlusion of either proximal (one patient) or mid-LAD (two patients). CONCLUSIONS: Demonstration of recanalized infarct-related left coronary artery soon after thrombolytic therapy is feasible. Locating the actual site of critical narrowing at bedside by TTE has important implications in the subsequent treatment of patients with acute anterior wall myocardial infarction.

Adult↗
PubMed1999

Perifollicular blood flow Doppler indices, but not follicular pO2, pCO2, or pH, predict oocyte developmental competence in in vitro fertilization.

OBJECTIVE: To assess the relationships among perifollicular blood flow; follicular fluid pO2, pCO2, and pH; oocyte developmental capacity; preimplantation embryo quality. DESIGN: Prospective study. SETTING: Academic, tertiary care institution. PATIENT(S): Unselected, gonadotropin-stimulated IVF cycles. INTERVENTION(S): Color, pulsed Doppler analysis of perifollicular blood flow, and follicular pO2, pCO2, and pH determinations of randomly designated, mapped ovarian follicles. MAIN OUTCOME MEASURE(S): Fertilization and day 3 embryo cleavage and morphology. RESULT(S): Perifollicular vascularity indices were significantly and negatively correlated with day 3 embryo cleavage. Pulsatility index and S-D ratio also were significantly and negatively correlated with follicular pO2. The same correlation was found between resistance index and the fertilization rate of preovulatory oocytes. No relationship existed between follicular metabolic analysis and fertilization or embryo quality. The resistance index had a sensitivity of 0.57 and a specificity of 0.71 for the prediction of advanced embryo cleavage status. CONCLUSION(S): Results confirm and extend previous reports demonstrating that color, pulsed Doppler ultrasound analysis of individual preovulatory follicles during IVF therapy may provide an indirect index of the developmental competence of the corresponding oocyte. Although these methods may provide means to select embryos for transfer with the highest implantation potential, the moderate predictive power showed so far may limit their clinical applicability.

Adult↗
PubMedDate not supplied

Post-traumatic high-flow priapism: management by superselective transcatheter autologous clot embolization and duplex sonography-guided compression.

High-flow priapism is caused by uncontrolled arterial inflow into the penis, often from direct arterial trauma. We report a case of arterial or high-flow priapism that was treated with a combination of selective transcatheter autologous clot embolization and duplex sonography-guided compression therapy. Sonography showed a pulsatile, anechoic area at the base of the penis inside the left corpus cavernosum after blunt perineal trauma, and color Doppler examination revealed an arteriosinusoidal fistula. Autologous clot embolization was only partially successful, and 3 sessions of ultrasound-guided compression therapy were necessary to achieve complete thrombus formation in the fistulous tract, which became isoechoic a day after compression therapy.

Adult↗
PubMed2001

Disseminated scleroderma of a Japanese patient successfully treated with bath PUVA photochemotherapy.

BACKGROUND: Localized scleroderma is known to be resistant to therapies. Recently, it has been reported that bath PUVA photochemotherapy is effective for treating this dermatosis. OBJECTIVES: Although according in earlier reports mainly white populations have been treated successfully with bath PUVA therapy, there is little knowledge of whether it is effective in treating colored populations. We treated a 64-year-old Japanese woman suffering from disseminated scleroderma with bath PUVA photochemotherapy to see its effects. CONCLUSION: Although rather high cumulative UVA doses were required for this patient compared with those needed in earlier reports, no adverse effects were observed. The lesions were markedly improved, suggesting that this therapeutic modality is well-tolerated and useful for colored patients such as the Japanese. Furthermore, it turns out that the thermographical assessment is useful to estimate clinical improvement of this sclerosing skin disorder.

Asian People↗
PubMed1999

Valvular heart disease.

Congenital and acquired valvular disease remains a frequent cause of morbidity and mortality. It presents a diagnostic challenge in all age groups, and often occurs in conjunction with other types of heart disease. Traditional chest radiography provides the earliest opportunity for radiologic diagnosis, hence the need for skill and knowledge in interpreting the radiographic findings. Echocardiography with color flow Doppler measurements is frequently the next modality applied. CT and MR imaging can simultaneously display cardiovascular morphology with greater spatial resolution than ultrasound, and at the same time provide quantitative assessment of cardiac function. The role of diagnostic imaging is therefore crucial, both for primary diagnosis and in the management of valvular heart disease. Furthermore, it is fundamental in evaluating the results of all forms of interventional therapy.

Echocardiography, Doppler, Color↗
PubMed1994

[Clinical evaluation of endoscopic variceal ligation (EVL)].

From August 1992 through February 1993, we treated 21 patients with endoscopic variceal ligation (EVL). Two patients had a history of the esophageal variceal bleeding, but 19 patients did not have bleeding episodes. To evaluate preventive effect of bleeding, we selected the patients who had grade F2 or red color sign positive varices. We repeated EVL until varices improved into grade F0 or F1 and red color sign negative. The therapeutic goal was sometimes changed according to patient's general condition. No additional therapy was performed to eradicate varices, such as endoscopic injection sclerotherapy. As a result of our therapy, eradication rate was 73.7% and period of hospitalization were 25 +/- 11 days. No major complications were found during and after EVL. EVL affected neither liver function test nor size of gastric varices. Recurrent varices with red color sign were found in 4 patients, but easily controlled by retreatment with EVL. EVL seems to be convenient and effective therapy in our short-term study, and useful for preventive therapy of the esophageal variceal bleeding.

Aged↗
PubMed1997

[Post-interventional pseudoaneurysm: technique, status and indications of color Doppler-controlled compression treatment].

In a prospective 6-year study including 155 pts. with false aneurysm (FA) after peripheral interventions, treatment by color doppler-guided compression (CDGC) was evaluated. Diagnosis and treatment were performed 1-42h (mean. 21.5 h) after intervention, using 7.5 MHz transducers. The technique was to apply pressure on the tract connecting FA and artery, to occlude it until thrombosis would induce FA closure. The treatment was successful in 152/155 cases (98.1%), requiring compression for 7 to 65 min. (mean: 28.8 min.). In 3/155 pts. (1.9%) under coumarin therapy (INR > 3.0) a second treatment was necessary (INR < 2.3) to obtain FA closure. The treatment was well tolerated, only 42/155 pts. (27.1%) needed analgetics. During CDGC, in 19 cases (5.9%) vagal reactions were observed, furthermore 2 FA ruptures (1.3%, without sequelae). 2 cases developed a FA relapse (1.3%), both could be permanently closed by a second CDGC. In conclusion, under the condition of early diagnosis CDGC is a rapid, very effective, safe and non-invasive method to treat postinterventional FA. Conservative, interventional or surgical treatment is limited to few cases when CDGC is not feasible (infection, compression syndrome), or not successful.

Aneurysm, False↗