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El síndrome piriforme constituye una de las causas de dolor pélvico debido al atrapamiento del nervio ciático por el músculo piriforme. En la actualidad es un síndrome de difícil diagnóstico. El objetivo de este estudio es conocer la prevalencia de variaciones anatómicas en nuestra población que puedan contribuir a la aparición del síndrome piriforme. También se estudian medidas antropométricas del músculo piriforme y el nervio ciático para su posible aplicación en procedimientos de la región glútea.

Immunogenicity of tumour cells, immunomodulation and direct targeting of signalling pathways are promising avenues and matter of dated and innovative research in melanoma. Unfortunately, tumour cells are considered to be antigenic, but not immunogenic, either due to presentation of weakly recognized antigens or to the inability of the immune system to recognize them. However, spontaneous complete remission can be rarely observed in patients affected by melanoma, which are mainly attributed to the immune response against the tumour. Also, an elevated frequency of spontaneous humoral immune responses against tumour antigens was occasionally found in patients. These data confirm the existence of an interaction of the immune system with the tumour which can be used as a promising pathway for intervention and incorporates all portions of the immune system. The cancer immunotherapy approach is based on artificial activation of the immune system against the tumour and groups several types of treatments including immunization/vaccination but also modulation of immunity by cytokines or antibodies. Immunization approaches could either be based on undefined tumour antigens (e.g. whole tumour cells, tumour cell lysates, or tumour-antigen enriched fractions) or aimed at eliciting T-cell responses against specific tumour antigens. Novel and contemporary antigen-targeted therapy strategies, mainly directed to Cancer Testis and Heat Shock Proteins, leading to a possible active immunization against melanoma through Tcell specific activation, are discussed in this review.

The diagnosis of disorders of the peripheral nerves (PN) has traditionally been based on clinical and electrophysiological data since nerve tissue cannot be visualized on standard radiographs. More recently, however, nerve structures have been evaluated with magnetic resonance imaging (MRI) and ultrasound (US). The former modality is expensive and not available in all institutions. There are also some contraindications to its use, and the assessment of long nerves can be time-consuming since different coils must be used. Thanks to recent advances in sonographic software and hardware, US can now be used for in-depth assessment of the PN of the upper and lower limbs.

Recent improvements in ultrasound (US) software and hardware have markedly increased the role of this imaging modality in the evaluation of the musculoskeletal system. US is currently one of the main imaging tools used to diagnose and assess most tendon, muscle, and ligament disorders. Compared with magnetic resonance imaging, US is much less expensive; it has no contraindications and is also widely available. Diseases affecting the digital flexor system (DFS) require early diagnosis if treatment is expected to limit functional impairment of the hand. US scans performed with high-resolution, broad-band transducers allows superb visualization of the flexor tendons of the hand and the annular digital pulleys. In addition, dynamic US can be used to assess movement of the tendon within the pulleys during passive or active joint movements. This article examines the anatomy and US appearance of the normal DFS and reviews the US findings associated with the most common disorders affecting it.

Abstract. We describe a case of inferior glenohumeral subluxation or drooping shoulder secondary to acute calcific tendinitis of the rotator cuff. The various etiologies of drooping shoulder and the specific causes determining glenohumeral widening in our report are discussed. The importance in recognizing this uncommon complication of a common abnormal finding and correction by aspiration is stressed.

Abstract: Transvaginal ultrasonography (TVUS) is one of the preferred imaging modalities in patients with gynecologic problems because of its high diagnostic accuracy, noninvasiveness, and wide availability. In endovaginal scanning, the problem of sonic attenuation is much less significant than with the transabdominal approach in the evaluation of the viscera in the true pelvis. Placement of high-frequency, high-resolution probes within the vagina allows accurate assessment of all anatomic structures of the female reproductive tract within the pelvis, and, incidentally, a variety of pathologic conditions affecting the intestinal tract, the urinary system, the pelvic walls, vessels, lymph nodes, and peritoneum can be assessed by this technique. In this article, we show the appearances of nongynecologic lesions of the female pelvis as imaged with TVUS and discuss the clinical indications to this kind of study and the role of TVUS in guiding interventional maneuvers through the vaginal vault. All endovaginal scans were taken with transducers at frequencies of 5.0–7.5 MHz.

The diagnosis of nerve entrapment at osteofibrous tunnels relies primarily on clinical and electrodiagnostic findings. Recently, the refinement of high-frequency broadband transducers with a range of 5-15 MHz, sophisticated focusing in the near field, and sensitive color and power Doppler technology have improved the ability to evaluate peripheral nerve entrapment in osteofibrous tunnels with ultrasonography (US). In the upper limb, osteofibrous tunnels amenable to US examination include the carpal tunnel for the median nerve and the cubital and Guyon tunnels for the ulnar nerve. In the lower limb, these tunnels include the fibular neck for the common peroneal nerve, the tarsal tunnel for the posterior tibial nerve, and the intermetatarsal spaces for the interdigital nerves. High-resolution US allows direct imaging of the involved nerves, as well as documentation of changes in nerve shape and echotexture that occur in compressive syndromes. A spectrum of extrinsic causes of entrapment, such as tenosynovitis, ganglia, soft-tissue tumors, bone and joint abnormalities, and anomalous muscles, can also be diagnosed with US. With continued experience, it is likely that this technique will be increasingly used to evaluate nerve entrapment syndromes.

Abstract: A case of meniscal ossicles occurring in the left knee of a 23-year-old woman is presented. Radiographs showed two calcified lesions at the posteromedial aspect of the knee which were interpreted as loose bodies. Sonography, computed tomography arthrography and magnetic resonance imaging showed the fragments within the posterior horn of the medial meniscus permitting a diagnosis of meniscal ossicles. These techniques can detect meniscal ossicles and exclude intra-articular loose bodies.

Abstract: Objective. To analyze peripheral nerves with ultrasonography (US) and magnetic resonance imaging (MR) in leprosy and assess the role of imaging in leprosy patients. Design and patients. Fifty-eight nerves with abnormal clinical features or electromyograms were examined in 23 leprosy patients by means of gray-scale US, Doppler US and MR imaging. Image analysis included: measurement of nerve cross-sectional area; assessment of nerve structure and MR signal intensities; identification of nerve compression within osteofibrous tunnels; detection of endoneural color flow signals and Gd-DTPA enhancement. Correlations were made with clinical findings and a control group of 20 subjects. Fourteen nerves in active reversal reaction were followed up after therapy. Results. Leprosy nerves were classified into three groups based on imaging appearance: group I consisted of 17 normal-appearing nerves; group II, of 30 enlarged nerves with fascicular abnormalities; group III, of 11 nerves with absent fascicular structure. Group II nerves were from patients subjected to reversal reactions; 75% of patients with group III nerves had a history of erythema nodosum leprosum. Nerve compression in osteofibrous tunnels was identified in 33% of group II and 18% of group III nerves. Doppler US and MR imaging were 74% and 92% sensitive in identifying active reactions, based on detection of endoneural color flow signals, long T2 and Gd enhancement. In 64% of cases, follow-up studies showed decreased color flow and Gd uptake after steroids and decompressive surgery. Conclusions. US and MR imaging are able to detect nerves abnormalities in leprosy. Active reversal reactions are indicated by endoneural color flow signals as well as by an increased T2 signal and Gd enhancement. These signs would suggest rapid progression of nerve damage and a poor prognosis unless antireactional treatment is started.

Increased renal resistance detected by ultrasound (US) Doppler has been reported in severe essential hypertension (EH) and recently was shown to correlate with the degree of renal impairment in hypertensive patients with chronic renal failure. However, the pathophysiological significance of this finding is still controversial.

In this study, duplex Doppler sonography was used to evaluate flow changes within renal intraparenchymal vessels induced by extracorporeal shock-wave lithotripsy (ESWL). We have examined 20 patients with caliceal stones before, 1 h and 24 h after ESWL. Doppler waveforms were obtained both from arteries located near the stone and at least at 3 cm from it, and resistive index (RI) measured. A statistically significant increase of the RI (0.079 ± 0.039 mean increase; P < 0.001) was detected 1 h after ESWL in vessels located near the stone. After 24 h, RI tended to normalize (0.056 ± 0.037 mean decrease; P < 0.001). The residual difference (0.022 ± 0.043; P = 0.399) between mean RI values obtained near the stone before and 24 h after ESWL was mainly due to persistent elevated RI values in three patients with ESWL induced hydronephrosis. No significant RI changes were recognized in intraparenchymal vessels located far from the stone. In all patients, Doppler alterations were not associated with morphologic changes of renal parenchyma.

Hofbauer cells are a major cell type of the human placental villous core and they are particularly numerous at the beginning of pregnancy. In the present study we describe a method suitable to obtain HC suspensions in a highly purified form. These suspensions have been analyzed for surface markers using a battery of monoclonal antibodies. Of all the surface markers used, Hofbauer cells were only positive for 4F2, LeuM2 and LeuM3 monoclonals which mainly detect cells of the monocyte-macrophage lineage. Hofbauer cells were consistently negative for HLA-DR antigens, C3bR and T- or B-cell markers. Hofbauer cells appeared capable of phagocytosing latex beads, adhering to and spreading over plastic surface and secreting lysozyme. In contrast, they failed to originate an efficient respiratory burst in response to appropriate stimulation. Hofbauer cells were positive for ANAE with a perinuclear localization of the enzyme activity, but consistently negative for peroxidase. These observations suggest that they share a number of features with cells of the monocyte-macrophage lineage and yet have some distinctive properties.

The aim of this study was to evaluate the changes in volume, structure, and flow pattern of parathyroid glands in uremic patients with secondary hyperparathyroidism treated with long-term intravenous calcitriol (CTL) therapy. Ultrasonography was used to follow-up volume changes occurring in 18 enlarged glands in 11 patients during an 18-month period; in 6 of these cases, 11 glands were followed-up also with color-Doppler to monitor variations in flow pattern. Vascularization was classified using three grades: grade 0=no color signal; grade I=vessels covering less than 50% of glandular cross-sectional area; grade II=vascular signals covering more than 50% of glandular cross-sectional area. No significant changes in volume were demonstrated during the 18 months of follow-up. On the contrary, significant decrease in flow was observed with almost complete disappearance of color-Doppler signals. This finding related well with the observed decrease in parathormone blood levels. Lack of volume changes during medical therapy demonstrates the inability of US alone to monitor the effect of this treatment on the parathyroid glands. Conversely, the observed intraglandular flow reduction indicates the possibility to use color Doppler to monitor the effects of CLT in uremic hemodialyzed patients with secondary hyperparathyroidism. This imaging procedure can be proposed for follow-up of the response of the parathyroid glands to therapy.

It is currently under debate whether the pathogenesis of end-stage renal failure in non-insulin-dependent diabetes mellitus (NIDDM) is a consequence of microangiopathy alone. The aim of this study was to investigate intrarenal arteriosclerosis and its correlation with kidney function in NIDDM. In 36 diabetic subjects, and in 10 age- and sex-matched healthy control subjects we measured kidney volume and resistive index of the interlobar arteries by duplex Doppler ultrasonography. Clinical and metabolic parameters, renal function and vascular sequelae of the disease were also evaluated. In diabetic subjects resistive index (median 0.72, range 0.54–0.79) was higher than in control subjects (median 0.62, range 0.57–0.66) (2p< 0.002). Kidney volume and resistive index correlated with age (p< 0.004), body mass index (p< 0.001), mean blood pressure (p< 0.001), total and LDL cholesterol (p< 0.01) and creatinine clearance (p< 0.001 and < 0.01, respectively). Kidney volume also correlated with HbA1(p< 0.01) and resistive index with uric acid (p< 0.01). Lower body macroangiopathy was associated with increased resistive index and reduced kidney volume (2p< 0.05), while upper body macroangiopathy and microangiopathy were not. Our data suggest that macroangiopathy rather than microangiopathy is mainly responsible for impairment of kidney function in NIDDM. The resistive index of interlobar arteries seems to be a reliable marker of intrarenal arteriosclerosis and can be used as a non-invasive, easily available parameter of its evolution. [Diabetologia (1998) 41: 121–124]It is currently under debate whether the pathogenesis of end-stage renal failure in non-insulin-dependent diabetes mellitus (NIDDM) is a consequence of microangiopathy alone. The aim of this study was to investigate intrarenal arteriosclerosis and its correlation with kidney function in NIDDM. In 36 diabetic subjects, and in 10 age- and sex-matched healthy control subjects we measured kidney volume and resistive index of the interlobar arteries by duplex Doppler ultrasonography. Clinical and metabolic parameters, renal function and vascular sequelae of the disease were also evaluated. In diabetic subjects resistive index (median 0.72, range 0.54–0.79) was higher than in control subjects (median 0.62, range 0.57–0.66) (2p< 0.002). Kidney volume and resistive index correlated with age (p< 0.004), body mass index (p< 0.001), mean blood pressure (p< 0.001), total and LDL cholesterol (p< 0.01) and creatinine clearance (p< 0.001 and < 0.01, respectively). Kidney volume also correlated with HbA1(p< 0.01) and resistive index with uric acid (p< 0.01). Lower body macroangiopathy was associated with increased resistive index and reduced kidney volume (2p< 0.05), while upper body macroangiopathy and microangiopathy were not. Our data suggest that macroangiopathy rather than microangiopathy is mainly responsible for impairment of kidney function in NIDDM. The resistive index of interlobar arteries seems to be a reliable marker of intrarenal arteriosclerosis and can be used as a non-invasive, easily available parameter of its evolution. [Diabetologia (1998) 41: 121–124]

In questo lavoro, sulla base della nuova classificazione di Van der Knapp e Valk, sono state trattate le malformazioni congenite del Sistema Nervoso Centrale diagnosticabili nel feto e nel neonato con l'ecotomografia. Particolare attenzione è stata rivolta alla precisa caratterizzazione semeiologica di ciascuna malformazione nel tentativo di puntualizzare gli elementi necessari per una corretta diagnosi differenziale ecotomografica.

Pancreaticobiliary diversion is a surgical procedure undertaken for obesity. It consists of a distal gastrectomy with a long Roux-en-Y reconstruction, the enteroenterostomy being placed 200 cm distal to the gastroenterostomy and 50 cm proximal to the ileocaecal valve. Three intestinal limbs are recognized: (a) the alimentary loop from the gastroenterostomy to the enteroenterostomy; (b) common loop from the enteroenterostomy to the ileocaecal valve and (c) pancreaticobiliary loop from the duodenum to the enteroenterostomy. The radiological findings in 15 pancreaticobiliary diversion patients with small bowel obstruction were reviewed (15 plain abdominal radiographs, 13 ultrasound (US), 8 CT) and compared with 20 plain abdominal radiographs, 10 US, and 10 CT studies performed for other causes in patients with pancreaticobiliary diversion and 15 CT scans from non-operated patients. After pancreaticobiliary diversion the pancreaticobiliary loop was completely air-free. In the patients operated on more than 1 year previously, alimentary and common loops were significantly larger than the pancreaticobiliary loop and small bowel loops of non-operated subjects. Obstruction of the pancreaticobiliary loop arrests only the flow of pancreaticobiliary secretions with non-specific clinical findings. Plain abdominal radiographs were not diagnostic in all but two cases with radiographically detectable dilated fluid filled loops. Air–fluid levels were never apparent. US and CT showed markedly dilatated intestinal loops and duodenum. Obstruction of the alimentary and common loops presented with symptoms, clinical signs, and radiological findings more typical for bowel obstruction in intact subjects.

Abstract.: Power Doppler sonography (PD) is a technique that displays the strength of the Doppler signal, rather than the flow velocity and directional information. Its increased flow sensitivity and better vascular delineation have been used to document the presence and characteristics of flow in vessels that are poorly imaged with conventional color Doppler (CD), to identify areas of ischemia, to demonstrate inflammatory hyperemia or increased and irregular flow in tumors, as well as to assess serial vascular changes related to interval therapy. The present review reports the general principles of PD, portrays the results of clinical studies available in the literature, and suggests future trends of development.

Abstract.: The aim of our study was to analyze changes in spectral Doppler waveforms between interlobar and interlobular arteries in renal transplants and to determine whether sampling location at interlobular level can be suitable for intrarenal resistive index (RI) measurements. Paired series of spectral tracings from interlobar arteries and respective interlobular branches were obtained in 62 consecutive renal transplants at 6.5-MHz Doppler frequency. The values of peak systolic velocity (PSV), end diastolic velocity (EDV) and RI were significantly (P < 0.01) reduced when calculated at interlobular level. In 38 % of cases, an interlobar RI higher than 0.70 corresponded to a normal interlobular RI. The values of PSV, EDV, and RI did not differ significantly at interlobular level between allograft subsets with normal and elevated serum creatinine level. Both intra- and interobserver variation were higher at interlobular than at interlobar level when performing the RI. During a conventional study of renal vasculature, an underestimation of abnormal RI findings can be expected from the incidental evaluation of interlobular tracings. We recommend sonologists to pay attention in accurately locating the sample volume at interlobar–arcuate level when evaluating intrarenal RI.

Morphological changes in fixed stromal cells and Hofbauer cells were studied throughout pregnancy in different types of placental chorionic villi by scanning electron microscopy. In the mesenchymal villus the fixed stromal cells were characterized by thin cytoplasmic processes. Hofbauer cells exhibited blebs on their surface. Large sail-like processes with a crescent profile which surrounded well developed stromal channels and a small cell body typified the small reticulum cells of the immature intermediate villus. The Hofbauer cells here displayed blebs, microplicae and large lamellipodia. Short cytoplasmic expansions and a large cell body characterized the fibroblasts present inside the stem villus. Hofbauer cells were rare, having blebs or a few short lamellipodia. The mature intermediate villus contained small and large reticulum cells. The latter had a much larger cell body than the small ones and displayed a few short cytoplasmic processes partly delimiting narrow incomplete stromal channels. Occasional Hofbauer cells with small microplicae and/or blebs were present. The small reticulum cells and fibroblasts present in the terminal villus showed similar morphological features as above. However, the former exhibited less developed cytoplasmic extensions and therefore no stromal channels were observed. In the terminal villus, the morphology of the rare Hofbauer cells was similar to that found in the mature intermediate villus.

To evaluate the ultrasound (US) appearance of the normal Achilles tendon at increasing frequency and establish an anatomical correlation for US findings, 30 normal tendons were examined in vivoand three in vitrowith 10 MHz and 15 MHz mechanical sector probes. Side-by-side comparison was performed in vitrobetween the sonograms and the corresponding anatomical sections. Two tendinous portions were detected by presence of an internal acoustic interface which had different appearances: one (type I) or two (type II) continuous lines of increased thickness and greater reflectivity than adjacent fibrils; or displacement (type III) of the distal portion of the well insonated sector of the tendon body. When, on coronal scans of the tendon, no intratendinous linear echoes of increased reflectivity were visible, the two portions of the tendon were identified through the converging course of their bundles (type 0 pattern). Different echogenicity allowed the detection of two tendinous portions, also on axial images. Scanning of isolated tendons allowed precise location of these interfaces at the boundary between anatomically distinct tendinous portions arising from the soleus and gastrocnemius muscles. Although the normal Achilles tendon is commonly regarded as a uniform structure by US, the use of high resolution probes allows identification of its constituent portions. Their identification may be useful to avoid misdiagnoses of pathological findings.

A case of primary non-Hodgkin's lymphoma (NHL) of the mandible with unusual radiographic presentation is reported. The panoramic radiography revealed diffuse widening of the right mandibular canal with ill-defined margins and absence of edge sclerosis. Computed tomography showed infiltration of the superior portion of the canal with involvement of the vestibular cortex of the bone and of the alveolar ridge.

At present, magnetic resonance is a useful modality for the diagnostic assessment of focal nodular hyperplasia of the liver. In the pediatric age group, diagnosis for this kind of pathology is more effective and conclusive when performed by MR, because of the limited variety and the restricted expression of primary hepatic tumors. MR diagnosis is based on the presence of a central connective tissue that is scar hyperintense on T2-weighted sequences, which can be regarded as a typical finding, though not specific. The other criteria used to differentiate it from primary malignant tumors on MRI are the homogeneity of the tissue surrounding the scar and its signal intensity, which is similar to that of adjacent normal hepatic parenchyma.

Imaging of the gallbladder demonstrates a wide range of anatomical variants, including anomalies in location, number and shape. Duplication anomalies are quite rare and are characterized by a large variety of configurations depending on the size and degree of fusion of the two lobes, and on the number and disposition of the cystic ducts. We present a case of a deeply cleft, bilobed gallbladder imaged by computed tomography (CT), ultrasonography (US) and oral cholecystography (OCG). The anomaly consisted of complete duplication of the body and fundus into two distinct and separated lobes both of which entered a single infundibulum. Awareness of congenital gallbladder variants may help in recognizing and correctly classifying gallbladder abnormalities, thus preventing misdiagnoses.