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Cardiac surgery can have severe neurologic complications. The noninvasive monitoring of intracranial circulation during heart surgery is usually performed with transcranial Doppler ultrasonography. We present the case of a 66-year-old man who underwent elective cardiac surgery for aortic valve replacement and coronary artery bypass graft, in whom monitoring was performed by simultaneously assessing blood flow velocity in the central retinal artery and vein

The aim of this study was to investigate liver microvascular adaptation following the intraportal infusion of pancreatic islets (pancreatic islet transplantation [islet-tx]) in diabetic patients using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). DCE-MRI was performed before and 7 days after islet-tx in six diabetic patients. Initial area under curve (AUC60) and volume transfer coefficient (Ktrans) were assessed as markers of liver perfusion. Clinical and metabolic monthly follow-up was performed in all patients, considering fasting C-peptide and β-score as main indices of graft function. High variability in the response of liver microvasculature to islet infusion was observed: two patients showed a significant reduction in liver perfusion after transplantation (pt.2: AUC60 = −23.4%, Ktrans = −31.7%; pt.4: AUC60 = −23.7%, Ktrans = −27.9%); three patients did not show any significant variation of liver perfusion and one patient showed a significant increase (pt.3: AUC60 = +31%, Ktrans = +42.8%). Interestingly, a correlation between DCE-MRI parameters and indices of graft function was observed and, in particular, both patients with DCE-MRI evidence of posttransplantation liver perfusion reduction experienced premature graft failure. Our preliminary study demonstrated that DCE-MRI may identify different adaptive responses of liver microvasculature in patients submitted to islet-tx. These different responses could have an impact on islet engraftment, although reported findings need confirmation from larger studies.

OBJECTIVE To compare prospective electrocardiogram (ECG)-triggered high-voltage coronary computed tomography (CT) angiography (CTA; 140-kVp P-cCTA) with retrospective ECG-gated standard-voltage cCTA (120-kVp R-cCTA), in patients with coronary stents. METHODS Fifty-two patients with coronary stents were studied with 64-slice multidetector scanner. Ninety-three stents were analyzed: 55 with 140-kVp P-cCTA and 38 with 120-kVp R-cCTA. Image quality (IQ), diagnostic confidence (DC), in-stent assessable lumen, artificial narrowing, and effective radiation dose were compared between techniques. RESULTS Image quality and DC were significantly better for the 140-kVp P-cCTA in comparison with the 120-kVp R-cCTA (IQ, 1.1 ± 0.36 vs 1.7 ± 0.60, respectively; P < 0.00001. Diagnostic confidence: 1.1 ± 0.29 vs 1.5 ± 0.65 respectively; P < 0.0001). In-stent assessable lumen and artificial narrowing were comparable between the techniques. Effective dose was lower for the 140-kVp P-cCTA (6.7 ± 2.07 mSv vs 15.8 ± 6.89 mSv; P < 0.0001). CONCLUSIONS High voltage combined with axial prospective ECG-triggered scan improved IQ and DC in stent cCTA imaging but failed to improve the diameter of in-stent assessable lumen and to reduce the artificial narrowing compared with the 120-kVp R-cCTA. Effective dose was 60% lower for the 140-kVp P-cCTA.

Beta-blockers have been shown to improve left ventricular (LV) function in patients with heart failure. The aim of this study is to non-invasively assess, by means of in vivo 31P-magnetic resonance spectroscopy (31P-MRS), the effects of beta-blockers on LV cardiac phosphocreatine and adenosine triphosphate (PCr/ATP) ratio in patients with heart failure. Ten heart failure patients on full medical therapy were beta-blocked by either carvedilol or bisoprolol. Before and after 3months of treatment, exercise testing, 2D echocardiography, MRS, New York Heart Association (NYHA) class, ejection fraction (EF), maximal rate-pressure product and exercise metabolic equivalent system (METS) were evaluated. Relative concentrations of PCr and ATP were determined by cardiac 31P-MRS. After beta-blockade, NYHA class decreased (from 2.2±0.54 to 1.9±0.52, P=0.05), whereas EF (from 33±7 to 44±6%, P=0.0009) and METS (from 6.74±2.12 to 8.03±2.39, P=0.01) increased. Accordingly, the mean cardiac PCr/ATP ratio increased by 33% (from 1.48±0.22 to 1.81±0.48, P=0.03). Beta-blockade-induced symptomatic and functional improvement in patients with heart failure is associated to increased PCr/ATP ratio, indicating preservation of myocardial high-energy phosphate levels. © 2012 Société Française de Pharmacologie et de Thérapeutique. Published by John Wiley & Sons Ltd

Le cardiomiopatie (CMP) costituiscono un eterogeneo gruppo di patologie associate a disfunzione cardiaca, secondo la definizione fornita dalla Task Force della WHO-ISFC nel 1995 [1]. Le cardiomiopatie sono state classificate in: dilatativa (CMD), ipertrofica (CMI), restrittiva (CMR), aritmogena del ventricolo destro (MAVD), nel gruppo delle cardiomiopatie specifiche (CMS); infine, il gruppo delle cardiomiopatie non classificabili include i casi che non rientrano negli altri gruppi, e che quindi sono stati esclusi dalla classificazione stessa (Tabella 10.1) [1].

AIMS:Few longitudinal imaging studies of liver-engrafted islets after islet transplantation are available for islet-transplant-alone (ITA) and islet-after-kidney (IAK) transplanted patients. Particularly controversial is the link between islet function and the appearance of islet-induced liver focal fatty changes. Aims of this study were to assess liver focal fatty changes at ultrasound after islet transplantation and their relationship with islet function.METHODS:The timing of first ultrasound detection of liver focal fatty changes and the prevalence and duration of these changes were assessed in 30 IAK transplanted patients, in five ITA patients and, retrospectively, in full-, partial- and no-function groups, according to islet function evaluated 1 year after transplantation. Patients with persistent ultrasound detected liver focal fatty changes underwent liver biopsy. Ultrasound positive and negative patients with functioning islets were compared for islet-function and C-peptide-levels during the follow-up. Variations of cholesterol/triglycerides and other metabolic parameters were also recorded at 1 year.RESULTS:Liver focal fatty changes at ultrasound were found in 12 patients (10/30 IAK, 2/5 ITA). First detection was at 6 months in eight cases and at 12 months in four cases. Liver ultrasound changes were of more than 1 year duration in eight cases. Steatosis was found histologically in 8/8 patients. At 12 months, liver ultrasound changes were detected to a greater extent in patients with partial islet function (10/12, eight IAK, two ITA) compared with patients with full islet function. C-peptide-levels were significantly lower in ultrasound-positive than in ultrasound-negative patients. At 18 months, ultrasound- positive patients were more prone to worsening of their function (9/12) compared with ultrasound-negative patients (3/18). No statistically significant differences of cholesterol/triglycerides levels were found in either the total number of patients or the IAK and ITA patients.CONCLUSIONS:Liver focal fatty changes at ultrasound (steatosis) after islet transplantation in IAK and ITA patients may represent an early sign of altered graft function.

Magnetic resonance imaging (MRI) provides non-invasive, repetitive measures in the same individual, allowing the study of a physio-pathological event over time. In this study, we tested the performance of 7 Tesla multi-parametric MRI to monitor the dynamic changes of mouse skeletal muscle injury and regeneration upon acute ischemia induced by femoral artery dissection. T2-mapping (T2 relaxation time), diffusion-tensor imaging (Fractional Anisotropy) and perfusion by Dynamic Contrast-Enhanced MRI (K-trans) were measured and imaging results were correlated with histological morphometric analysis in both Gastrocnemius and Tibialis anterior muscles. We found that tissue damage positively correlated with T2-relaxation time, while myofiber regeneration and capillary density positively correlated with Fractional Anisotropy. Interestingly, K-trans positively correlated with capillary density. Accordingly, repeated MRI measurements between day 1 and day 28 after surgery in ischemic muscles showed that: 1) T2-relaxation time rapidly increased upon ischemia and then gradually declined, returning almost to basal level in the last phases of the regeneration process; 2) Fractional Anisotropy dropped upon ischemic damage induction and then recovered along with muscle regeneration and neoangiogenesis; 3) K-trans reached a minimum upon ischemia, then progressively recovered. Overall, Gastrocnemius and Tibialis anterior muscles displayed similar patterns of MRI parameters dynamic, with more marked responses and less variability in Tibialis anterior. We conclude that MRI provides quantitative information about both tissue damage after ischemia and the subsequent vascular and muscle regeneration, accounting for the differences between subjects and, within the same individual, between different muscles.

We studied the main ocular and retrobulbar vessels with color-Doppler US and report on examination technique, detectability of the vessels and their flow characteristics to define the normal ranges of Doppler spectra for each artery and vein. We comparatively examined both eyes of 20 healthy subjects. Of each eye we studied the ophthalmic artery, the central retinal artery, the ciliary artery, the central retinal vein and the superior ophthalmic vein. The following flow parameters were considered: peak systolic velocity, end-diastolic velocity and resistive index for arteries; maximum and minimum velocity for veins. The examination lasted about 10 minutes per eye--20 minutes for each subject. In all subjects the five investigated vessels were identified in both eyes, and adequate Doppler spectra were obtained. The average peak systolic velocities of ophthalmic, central retinal and ciliary arteries were respectively about 35, 12 and 10 cm/s, with low resistance patterns (resistive index: 0.75, 0.72 and 0.68, respectively). The venous flow, which is usually continuous, may be sometimes influenced by cardiac and respiratory activities: the maximum velocities of superior ophthalmic and central retinal veins were about 6 and 5 cm/s, respectively. Color-Doppler US noninvasively visualizes both ocular and retrobulbar vessels, providing major hemodynamic information from different flow parameters; the knowledge of these parameters in normal conditions can be the basis of hemodynamic studies in many abnormal orbital conditions.

This study was aimed at assessing the Magnetic Resonance (MR) features of persistent hip pain in children. Twenty-six patients aged 1.6 to 15.2 years (mean: 6.5 years) were clinically selected for the study; at clinics, all patients had persistent hip pain after 10 days' therapy. All patients were examined with radiography, US and MRI at 0.5 T. SE T1-weighted sequences, with and without fat suppression (FS), SE T2-weighted and gradient echo (GE) T1-weighted-like (T1*) sequences were acquired on the coronal plane. Slices were 5 and 3 mm thick on SE and GE T1* sequences, respectively. Morphology and signal intensity of epiphysis, growth plate and metaphysis were prospectively studied with MRI. Clinical and/or imaging follow-up (3 months) was the reference standard in our study. Final diagnoses were: no evidence of alteration (n = 3), transient synovitis (n = 6), rheumatic fever (n = 3), Perthes' disease (n = 7), Meyer's dysplasia (dysplasia epiphysealis capitis femoris, DECF) (n = 2), early slipped capital femoral epiphysis (n = 2), incomplete fracture (n = 1), extraarticular cause of pain (muscular abscess, osteomyelitis) (n = 2). In 23 of 26 patients MRI confirmed clinical, radiographic and US findings. MRI was particularly helpful in making an unquestionable diagnosis in the other 3 cases; in a patient with suspected slipped capital femoral epiphysis MRI revealed an incomplete fracture, in a patient with suspected Meyer's dysplasia MRI revealed early Perthes' disease and finally in a patient with suspected transient synovitis MRI revealed Perthes' disease. To conclude, MRI allows the condition causing persistent hip pain to be assessed and accurately depicted, integrating clinical, radiographic and US findings and in some cases also changing diagnosis and therapy.

This work was aimed at assessing Magnetic Resonance (MR) accuracy in the preoperative investigation of abdominal aortic aneurysms, with a view to suggesting MRI as the method of choice for surgical planning, replacing other relatively invasive investigation techniques like angiography and enhanced CT. In the last 3 years 80 patients with abdominal aortic aneurysms identified with US or CT were examined with 0.5-T MRI and underwent surgical repair within 15 days. Spin-echo (SE) T1-weighted axial, sagittal and coronal sequences were always performed. In 18 patients gradient-echo (GE) flow sequences were also acquired; SE T2-weighted sequences were used to study parietal thrombi in 10 patients and finally Gd-DTPA T1-weighted sequences were obtained in inflammatory aneurysms (3 patients). MR images were blindly evaluated by 2 radiologists. The following variables which are useful for surgical planning were considered for each patient: aneurysm extent, characteristics of parietal thrombi, dissections, fixurations, inflammation signs, involvement of renal arteries, vena cava, ureters, duodenum, the presence of retroaortic renal vein or of other anomalies or associated conditions. MR images were always compared with intraoperative findings, since surgery was considered as the gold standard. MR findings were in agreement with surgical findings in the evaluation of cranio-caudal aneurysm extent (78/80), parietal thrombus features (80/80), dissection (1/1) and fixuration signs (8/9), origin of renal arteries (80/80), inferior vena cava involvement (3/3), other anatomical anomalies or conditions (6/6). Inflammation signs were overestimated (14/8) as well as adhesion between aneurysm and duodenum (17/13). The presence of distal renal polar arteries was underestimated (2/4). In conclusion, MRI proves to be a highly sensitive method to demonstrate abdominal aortic aneurysms and is therefore suggested as the examination of choice before surgery.

Cholelithiasis as a cause of jaundice in the neonatal period is rare. We are going to describe a case of cholestasis with cholangitis due to calculus of choledochus. None of the causes favouring cholelithiasis described in medical studies proved to be present. The diagnosis was made through an ultrasonographic check of the upper abdomen. The case resolved spontaneously. Our case suggests a cautious attitude and careful clinical and echographic monitoring.