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Introduction: Couples who have not achieved a pregnancy within one year of unprotected intercourse qualify for a fertility work-up. A semen analysis is part of this work-up and includes the assessment of sperm concentration, motility and morphology. The predictive value of sperm morphology has been

OBJECTIVE. We sought to investigate the efficacy of contrast-enhanced sonography using a second-generation contrast agent for the evaluation of hepatocellular carcinoma in patients with cirrhosis by comparing the results to those obtained with contrast-enhanced helical CT. SUBJECTS AND METHODS. Between October 2002 and March 2003, 74 patients with cirrhosis (60 men and 14 women; age range, 47–80 years; mean age, 67 years) who had a single nodule of hepatocellular carcinoma were selected to be studied from a cohort of 437 patients with cirrhosis. The size range of the 74 nodules was 9–65 mm (mean, 28.2 mm). Twenty-eight (38%) were 20 mm smaller (range, 9–20 mm; mean, 16.6 mm), and 46 (62%) were larger than 20 mm (range, 21–65 mm; mean, 35.2 mm). Contrast-enhanced sonography was performed at a low mechanical index after IV administration of the contrast agent Sono- Vue. CT scans were obtained in all patients. The enhancement pattern related to tumor hypervascularity was analyzed. The chi-square test was used for statistical analysis. RESULTS. For the 28 hepatocellular carcinomas 20 mm or smaller, contrast-enhanced sonography showed 15 (53.6%) as hypervascular and 10 (35.7%) as avascular; three (10.7%) carcinomas were missed. On CT, 12 (42.9%) of the 28 hepatocellular carcinomas appeared hypervascular, 13 (46.4%) appeared hypovascular, and three (10.7%) were missed. For the 46 hepatocellular carcinomas larger than 20 mm, contrast-enhanced sonography showed 42 (91.3%) as hypervascular and four (8.7%) as avascular. On CT, 35 (76.1%) hepatocellular carcinomas appeared hypervascular, eight (17.4%) appeared hypovascular, and three (6.5%) were missed. Differences between CT appearance of hepatocellular carcinomas and contrastenhanced sonographic appearance of the carcinomas were not statistically significant. Concordance between contrast-enhanced sonographic and CT appearances was observed in 61 (82.4%) of 74 cases. CONCLUSION. Contrast-enhanced sonography is similar to CT for detecting hepatocellular carcinoma hypervascularity. It could be complementary to conventional unenhanced sonography for evaluation of liver nodules.

Objective. To verify the role of sonography in screening of acute appendicitis in patients admitted to an infectious disease unit for suspected acute infectious enteritis. Methods. One hundred eighty consecutive patients (102 male and 78 female; age range, 5-72 years; mean age, 31 years) admitted for suspected infectious enteritis or typhoid fever were prospectively studied with abdominal sonography within 48 hours after admission. None of the patients had peritoneal irritation. Forty-six patients (25%) had white blood cell counts of more than 10,000/mm 3 (range, 10,300-18,000/mm 3 ). The diagnosis of acute appendicitis was made when a detectable appendix with an anteroposterior diameter of greater than 7 mm could be seen on sonography. Results. Eleven (6%) of 180 patients had thickened appendixes (anteroposterior diameter range, 7-14 mm); 2 of them had periappendiceal abscesses. Four (36%) of 11 patients with acute appendicitis had high white blood cell counts. All sonographic diagnoses of acute appendicitis and periappendiceal abscesses were confirmed at surgery. Sonography ruled out acute appendicitis in 169 patients. In all of them, clinical and sonographic follow-up excluded the diagnosis of acute appendicitis. Normal appendixes were shown on sonography in 38 (22%) of 169 cases and were not detectable in 131 (78%) of 169. Conclusions. Sonography of the appendix is a useful method for early assessment of acute appendicitis in patients thought to have enteritis or typhoid fever.

The purpose of our study was to analyze the efficacy, side effects, and short-term complications of saline-enhanced percutaneous radiofrequency ablation performed under sonographic guidance in a series of cirrhotic patients with hepatocellular carcinoma. SUBJECTS AND METHODS. Between September 2000 and June 2002, 84 patients (55 men and 29 women) with cirrhosis who ranged in age from 48 to 74 years (mean age, 64 years) and who had 95 hepatocellular carcinomas (seven patients had two tumors and two patients had three tumors) were treated with high frequency-induced thermotherapy. The diameters of the tumors ranged from 1.5 to 8.5 cm (mean, 3.6 cm). The efficacy of radiofrequency ablation was evaluated with triphasic contrast-enhanced CT performed 4 weeks after the procedure.Posttreatment CT showed complete necrosis in 73 (77%) of 95 hepatocellular carcinomas in 62 patients. Complete necrosis based on tumor size was seen in 40 (95%) of 42 tumors with diameters equal to or smaller than 3 cm, 32 (71%) of 45 tumors with diameters between 3.1 and 5.0 cm, and one (12%) of eight tumors with diameters larger than 5.0 cm. Twenty-two hepatocellular carcinomas showed incomplete necrosis. None of the patients experienced major complications. Four patients were lost to follow-up. The length of the follow-up period ranged from 4 to 22 months (mean, 10 months). One patient died 8 months after the radiofrequency ablation treatment. All the remaining patients are still alive. During the follow-up period, eight (10%) of 80 patients showed a local recurrence on sonography and CT.Our experience suggests that percutaneous radiofrequency ablation of hepatocellular carcinoma with high frequency-induced thermotherapy is safe and effective in the treatment of hepatocellular carcinomas equal to or smaller than 3 cm, fairly effective for hepatocellular carcinomas between 3 and 5 cm, and ineffective for tumors larger than 5 cm.

Forty-six patients with cirrhosis and 75 biopsy-proved hepatocellular carcinoma (HCC) nodules underwent percutaneous ethanol injection (PEI) regardless of number (up to five) and size (mean diameter, 3.6 cm) of tumoral lesions and clinical severity of cirrhosis (11 patients in Child's class C were included). Ethanol was injected under sonographic guidance through 20 to 22 gauge needles so as to obtain homogeneous hyperechogenicity of lesions. A total of 271 PEI sessions were carried out, delivering 2 to 14 ml per session. All nodules but one decreased in size, and seven were no longer appreciable on sonography. Recurrence was detected in two patients. The 3 year survival rate of all cases was 86%. Child's classes A and B patients fared better (3 yr survival 100%); 2 year survival of subjects with HCC < or = 3 cm was 92%. Multifocality did not affect survival. Most patients experienced mild pain at the site of injection, but only two major complications were encountered: partial chemical thrombosis of the left portal vein and cholangitis. Both cases were managed conservatively. In conclusion, PEI seems to offer a safe and valuable tool for therapy of HCC, especially in patients with good functional liver reserve and small (< or = 3 cm) tumors.

To define the epidemiologic and clinical significance of delta infection in the Naples area, we sought anti-delta antibodies in all cases of HBV-associated liver diseases, hospitalized in our department during 1983 (234 acute hepatitis, 9 of which fulminant; 51 chronic hepatitis; 32 cirrhosis; 19 hepatocarcinomas) and in randomly selected acute hepatitis over the previous 6 years. Delta agent in acute forms and IgM anti-HBc in delta-positive acute forms were also tested. The acute cases were controlled for at least 9 months after dismissal. Delta infection showed a high prevalence in the Naples area (20% of all acute cases in 1983; similar prevalences in previous years; high rate of coinfections, 81%; no peculiar modalities of circulation) and a high pathogenicity, as proved by the greater prevalence in fulminant cases (66.7%) and severe chronic forms. Moreover superinfection appears a more dangerous event than coinfection as regards the diseases becoming chronic (77.8% vs 2.5%).

Seven hundred ninety-one consecutive patients with acute viral hepatitis, 17 of whom had liver failure, and 97 healthy volunteers were examined by ultrasound. No specific patterns were found in either the uncomplicated or the complicated forms. Only 19 subjects showed a typical "bright liver" pattern, which is correlated with significant vacuolar hepatocellular degeneration. The increased brightness and clear visualization of portal vein radicle walls, previously described in this disease, were detected in only 32.2% of the hepatitis patients but were also seen in 30.9% of the normal controls.

To verify the value of ultrasound (US) in the diagnosis of cirrhosis, the ratio of transverse caudate lobe width to right lobe width (C/RL) was determined with US in 25 healthy subjects and 156 consecutive patients with either histologically proved acute viral, chronic persistent, or chronic active hepatitis or cirrhosis. The C/RL ratio had a sensitivity of 43%, a specificity of 100%, and an accuracy of 79% in cirrhosis. The sensitivity was very low in alcoholic cirrhosis, low in cryptogenic cirrhosis, and high in hepatitis B virus related cirrhosis. In spite of its fairly low overall sensitivity, the C/RL ratio is a useful measurement in assessing chronic liver disease because of its high specificity in cirrhosis.