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Radio-frequency catheter ablation (RFCA) of the distal pulmonary veins is increasingly being used to treat recurrent or refractory atrial fibrillation that doesn't respond to pharmacologic therapy or cardioversion. Successful RFCA of atrial fibrillation depends on the pre-procedural understanding of the complex anatomy of the distal pulmonary veins and the left atrium. Aim of this paper is to describe the technical main features that characterise the multidetector helical computed tomography in the evaluation of this anatomic region before and after RFCA procedure. The 3D post-processing techniques useful for pre-RFCA planning are straightforward.

Purpose: To confirm the diagnostic accuracy of percutaneous core breast biopsy with Mammotome and stereotactic equipment in upright seated patients, and to compare results from this method with those obtained using the dedicated unit with prone table., Materials and Methods: We analysed 72 microbioptic samples from 69 upright seated patients. These samples were obtained in the course of mammographies assisted by digital stereotactic equipment (Diamond Delta32 General Electric Medical System/Instrumen-tarium), and further equipped with a lateral arm to support the Mammotone probe. We studied the following lesions: 57 cases of isolated microcalcification clusters, 12 masses with microcalcification and three cases of plain masses. We describe in detail the various phases of our 30-minute long microbiopsy procedure. All 72 samples were extracted without problems. Only in one case a large haematoma emerged, but quickly disappeared., Results: We were able to characterise the histology of the lesions in all our samples: in 39/72 cases they were identified as benign, 28 were classified as malignant, and the remaining 5 as atypia. In the 39 lesions identified as benign, the microbiopsy procedure could be carried out without surgical biopsy - consequently, these patients were available for routine follow-up exams, which confirmed the benign nature of their lesions. Our identification of the 28 malignant lesions was confirmed by surgical biopsy. The microbiopsy finding and the histological result did not agree in only two cases. The 5 cases with atypical ductal hyperplasia showed no neoplastic alteration following surgical biopsy. In our personal experience, core biopsy with Mammotome achieved a high diagnostic accuracy., Conclusions: After careful analysis of the results obtained using Mammotome in upright seated patients with stereotactic equipment, we can confirm the diagnostic accuracy of this procedure in mammography alterations not visible in sonography. In agreement with previous studies, we also confirm that the diagnostic accuracy of this approach, as well as possible complications deriving from it, do not depend on the position of the patient.

Purpose: Amyloid shoulder arthropathy is a frequent finding in long-term hemodialysis patients. Assessing the symptoms is fundamental in the approach to these patients but their long life expectancy means that the correct imaging quantification of scapulohumeral joint impairment is just as important. We investigated the role of MRI in amyloid shoulder arthropathy in long-term hemodialysis patients., Material and Methods: From January, 1995, to December, 1996, twelve long-term (mean: 13 years) hemodialysis patients with amyloid shoulder arthropathy were examined with MRI. All of them had undergone physical examination to detect the most involved scapulohumeral joint. MRI was carried out with a 1.0 T Magnetom Impact unit (Siemens, Germany) using T1-weighted Turbo SE sequences at high resolution on coronal and sagittal planes, respectively parallel and perpendicular to the supraspinatus tendon, and FLASH sequences on the axial plane. Six patients were then submitted to surgery., Results: MRI had identified 3/12 rotator cuff tears (always involving the supraspinatus tendon and other tendons), 7/12 rotator cuff tears from supraspinatus tendon injury, and 1/12 thickening and structural dishomogeneity of the supraspinatus tendon. Finally, no structural changes were shown in 1/12 cases. In addition, most MR examinations (11/12) showed some inhomogeneous material characterized by intermediate-to-low signal intensity on T1-weighted sequences; such changes were found in subacromial and subdeltoid bursas in part of the articular capsule and were always associated with hypointense nodular images in all sequences. Surgery was carried out in 6 patients and confirmed both the structural changes of the rotator cuff and the presence of amorphous material which appeared to be amyloid deposits at subsequent histology. MRI proved to be a very reliable tool even in the study of skeletal structural changes, permitting both the identification of periarticular calcifications and the accurate analysis and quantification of subchondral erosions., Conclusions: MRI was a very reliable tool not only in the study of rotator cuff tears due to amyloid deposition but also in the analysis of bone changes. Thus MRI could play a growing role in treatment planning.

Screening and prophylaxis of the population at risk is the most correct approach to thromboembolic disease. Caval filters play a major role in the prevention of pulmonary embolism, but their use remains widely controversial, even if they are an alternative or additional method to medical therapy and not antithetical to it. July, 1990, to September, 1995, seventy-seven permanent vena cava filters (59 LGM, 13 Filcard and 5 titanium-Greenfield), 22 short-duration temporary vena cava filters (11 LGT, 6 Filcard, 3 Filcard-Emanuelli and 2 Lysofilter) and 10 mid-duration temporary vena cava filters (Tempofilter) were inserted in 109 patients (55 men and 54 women) aged 17-88 years. An inferior vena cavogram was always made before filter insertion to "map" the inferior vena cava and its tributaries (renal veins) and to assess caval size. This is a mandatory step to exclude or confirm the presence of endocaval thrombi. Sixty-eight filters were inserted percutaneously via a right internal transjugular approach, 40 via a common transfemoral approach (34 right and 6 left) using the same route as inferior cavography and digital pneumoangiography. One temporary filter was inserted via a right transhumeral approach. Sixty-three patients (57.8%) (44 with a permanent filter, 14 with a temporary filter and 5 with a Tempofilter) had medical diseases, 7 patients (6.4%) (4 with a permanent filter, one with a temporary filter and 2 with a Tempofilter) had surgical conditions; 10 patients (9.2%) (7 with a permanent filter and 3 with a Tempofilter) were surgical-orthopedic patients. Twenty-seven patients (24.8%) (22 with a permanent and 5 with a temporary filter) had cancer. Two patients (1.8%) with a temporary filter were breast feeding. All the patients had deep venous thrombosis of the lower limbs, including the inferior vena cava and the right renal vein in two patients. A proximal floating thrombus and a pulmonary thromboembolism was diagnosed in 41 (37.6%) and 34 (31.2%) cases, respectively. The temporary filters remained in situ 1-4 days and the Tempofilters 3-5 weeks. A pelvic hematoma developed (because of heparin?) after the insertion of a temporary filter and a Tempofilter branch detached and migrated into a lower branch of the left pulmonary artery were reported as immediate and short-term consequences. There were no early or late consequences for the patients. An axillary hemorrhage was observed in the site of previous surgery, during fibrinolysis with a Lysofilter, as well as the incomplete opening of a titanium-Greenfield filter and of two permanent LGM filters, partly trapped within endocaval thrombi. No further consequences to the patients due to permanent filters were observed, nor any case of symptomatic pulmonary thromboembolism, in patients with permanent or temporary filters. With reference to the relative literature and to their own experience, the Authors propose a detailed and rational synthesis of the diagnostic-instrumental approach protocol to thromboembolic disease.

Transrectal ultrasound (TRUS) was performed preoperatively in 35 patients with rectal carcinoma and the results were compared to histologic findings. In the same group, postoperative studies were performed in 22 patients; in women, transvaginal ultrasound (TVUS) was added to the transrectal study. According to Duke's classification modified by Astler-Coller, in relation to the "T" parameter, TRUS correctly staged 33 of 35 neoplasms (accuracy, 94.3%); one was overstaged and one was understaged. In detection of lymph node involvement, accuracy was 74% (sensitivity 69%, specificity 73.9%). Recurrent local tumors, histologically confirmed, developed in two of 22 postoperative patients who had undergone curative anterior resection. This study demonstrates that TRUS is an accurate method in preoperative staging of rectal carcinoma. In the prospective study, the role of follow-up TRUS and TVUS in detection of local recurrences is evaluated.

Transrectal sonography (TRUS) accurately assesses the depth of invasion in the staging of rectal carcinomas. However, the method is limited in the evaluation of upper rectal and highly stenotic rectal cancers. These conditions can be demonstrated in female patients by transvaginal sonography (TVUS) with a 5-MHz convex probe. Conventional TVUS becomes even more accurate when the rectum is distended with water. Twenty-one asymptomatic female patients were examined in a prospective study to assess the value of conventional versus water-distended TVUS. Water improves rectal depiction because it eliminates air and fecal artifacts. In our series, the rectum was demonstrated from anum to rectosigmoid junction in all cases. The whole rectal outline could also be demonstrated. Besides rectal lumen evaluation, the method allowed rectal wall layers and perirectal fat to be detailed. Subsequently, 14 female patients were examined--8 during the preoperative staging and 6 during the follow-up. In preoperative patients, the extent of stenosing rectal cancer and perirectal fat infiltration were assessed; in postoperative patients rectal recurrences were excluded. In conclusion, TVUS with rectal distension by means of water is a new diagnostic procedure which can markedly improve the US imaging of highly stenosing rectal cancers.

The initial and follow-up chest radiographs of 31 patients with the acquired immunodeficiency syndrome (AIDS) were reviewed to assess the spectrum and frequency of opportunistic pulmonary infections. In our series, the most common pulmonary infections seen on chest films were: Pneumocystis carinii pneumonia (PCP) (n = 17), PCP associated with Cytomegalovirus (CMV) (n = 2), PCP associated with Mycobacterium avium-intracellulare (MAI) (n = 1), Mycobacterium tuberculosis (n = 7), CMV (n = 2), MAI (n = 1) and Cryptococcus neoformans (n = 1). Diffuse or focal interstitial infiltrate is the most common finding in PCP; bilateral focal or multilobar interstitial infiltrates are also frequently observed: they are usually caused by PCP or by PCP associated with CMV. Infiltrating cavitating lesions and multiple interstitial well-defined nodules < 10 mm diameter were seen only in Mycobacterium tuberculosis infections. Normal chest findings and/or pleural effusions were uncommon; no case exhibited pulmonary cysts on initial radiographs. In this retrospective study we emphasize the high incidence of Mycobacterium tuberculosis infections; other pulmonary infections are emerging in AIDS. The X-ray patterns of pulmonary infections in AIDS must be known for a prompt and accurate diagnosis and to plan the appropriate treatment.

We report the first published case of megapolycalicosis with prenatal ultrasound diagnosis. Pyeloureteral junction dysplasia was observed only after delivery. The etiopathogenesis of megapolycalicosis (MPC) and its hypothetical association with uretero-pelvic junction obstruction are discussed. Presence of polycalicosis, good glomerular filtration and absence of compensatory controlateral renal hypertrophy are determinant in the diagnosis.

Between december 1983 and april 1989, percutaneous retrograde sclerotherapy of varicocele was successfully performed on 364 patients. A 5% solution of sodium morrhuate and benzylic alcohol (Varicocid) was administered through a coaxial balloon catheter inserted into the spermatic vein. 10 of the patients had relapses after surgery. Long-term follow-up was available for 268 patients (73.6%). Three of them had incomplete relapses after sclerotherapy. In terms of spermatologic improvement, sclerotherapy appeared to be effective in the treatment of varicoceles. In our experience, sclerotherapy is a safe effective procedure to be preferred to surgery in the management of varicocele.

Percutaneous transluminal angioplasty (PTA) of the superior mesenteric artery (SMA) was performed in a 65-year-old man with clinical and radiographic evidence of abdominal angina. The patient was relieved of abdominal pain immediately after the dilatation. At the angiographic follow-up (7 months later) the SMA was of normal caliber. At the last follow-up visit (14 months after intervention), the patient was still free of pain. PTA of SMA stenoses is an alternative to surgical revascularization, and can be repeated if symptoms recur.

Since December 1983, percutaneous transvenous retrograde sclerotherapy of the internal spermatic vein was performed successfully, without complications in 37 patients. The administration of the sclerosing agent through a coaxially balloon catheter specifically inserted into the spermatic vein caused therapeutic hardening. The effectiveness of the treatment was endorsed by subsequent checks by clinical and radiological examinations.

Hürthle cell tumors are a very particular thyroid disease. Controversies exist about the most adequate treatment. Radical surgery is sometimes advocated also for benign lesions, due to their malignant potential, but conservative surgery is thought to be adequate in most cases. The Authors' experience consists of 8 Hürthle cell tumors: 7 adenomas and 1 carcinoma. The latter has been treated by total thyroidectomy and the patient died after 6 months. Adenomas have been always treated by conservative procedures and there is no recurrence at a 2-6 year follow-up.

Between January 1984 and July 1988, percutaneous retrograde sclerotherapy of varicocele was successfully performed on 267 patients. A 5% solution of sodium morrhuate and benzylic alcohol (Varicocid) was administered through a coaxial balloon catheter inserted into the spermatic vein. Nine of the patients had relapses after surgery. Long-term follow up was available for 248 patients. Three of them had incomplete relapses after sclerotherapy. In terms of spermatologic improvement, sclerotherapy appeared to be effective in the treatment of varicoceles. In our experience, sclerotherapy is a safe and effective procedure to be preferred to surgery in the management of varicocele.