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Purpose: To assess the value of small bowel wall vascularity after microbubble contrast agent injection in evaluating the therapeutic effectiveness of specific anti-inflammatory treatment in patients with Crohn's disease., Materials and Methods: Fifteen patients (7 male and 8 female; mean age+/-SD, 40 years+/-6) with a biopsy-proven diagnosis of Crohn's disease--Crohn's disease activity index (CDAI)>150 (n=12 patients) or <150 (n=3)--involving the terminal loop of the small bowel (wall thickness>5 mm) were included. In each patient the terminal loop was scanned by contrast-enhanced ultrasound (CEUS) after sulfur hexafluoride-filled microbubble injection before and after 6-month anti-inflammatory treatment. The vascularity of the terminal loop was quantified in gray-scale levels (0-255) by a manually drawn ROI encompassing the thickened bowel wall and it was correlated with CDAI., Result: Before the beginning of the specific treatment all patients revealed diffuse transparietal contrast enhancement after microbubble injection, except for 3 patients who revealed contrast enhancement limited to the submucosa. In 13 patients the slope of the first ascending tract and the area under the enhancement curve were significantly lower after anti-inflammatory treatment (P<0.05; Wilcoxon test) with a significant correlation with the CDAI score (rho=0.85, P<0.05). In 2 patients no significant vascularity changes were found even though a mild reduction of CDAI score was identified (from 200 to 150 gray-scale levels)., Conclusion: CEUS is a useful method to assess the therapeutic effectiveness of specific medical anti-inflammatory treatment in patients with Crohn's disease.

In this paper we present an overview of CT-Urography. With the advent of multislice CT scanners and the evolution of image processing methods this technique now affords optimal urographic images comparable to those obtained with conventional techniques. We describe the acquisition techniques and protocols used by the various authors. Effective radiation dose has conditioned the use of CT-Urography so that the tendency today is to reduce the number of scans by performing, after the nonenhanced scan, a single contrast-enhanced scan comprising both the nephrographic and urographic phase. With the use of multislice CT the quality of the urogram improves with the number of slices. We illustrate a variety of processing techniques, multiplanar reconstruction (MPR), maximum (MIP) and average intensity projection (AIP) and volume rendering (VR) and present a series of upper urinary tract tumours testifying to the superiority of the AIP technique over MIP. We then review the results of comparative studies of CT-Urography with conventional urography in upper urinary tract diagnostics. Finally, we describe the advantages and limitations of CT-Urography.

The main pleural disorders are: effusion, thickening, masses and pneumothorax. Chest radiography is the first approach to evaluation of pleural disease; further evaluation is based upon ultrasounds (US), computed tomography (CT), and high-resolution CT (HRCT). The typical appearance of free pleural effusion is a homogeneous opacity with concave upper boundary; subpulmonic or intrafissural collections may also occur; the exudative effusions can be organized by adhesions between the pleural layers; consequently, loculated collections result. Radiographs allow us to assess the presence, amount and arrangement of effusions, but US and, especially, CT are needed to detect the modifications of the underlying pleura: circumferential thickenings, irregular and more than 1 cm thick are mostly malignant and denote mesothelioma or metastases: subtle and regular thickening is the typical appearance of fibrosis; a normal pleura does not exclude a malignant effusion. CT plays a major role in the diagnosis and management of empyema and in differentiating it from the pulmonary abscess. With CT it is also possible to differentiate the true pleural thickening from the false one due to a simple increase of extrapleural fat, and to disclose the activity of a fibrothorax through the detection of a small amount of fluid between the pleural layers. Pleural plaques are clearly visible by conventional radiography, especially with oblique views; US and CT are needed in the assessment of pleural tumors (fibroma, lipoma, fibro- and liposarcoma) and in determining the involvement of the lung and the chest wall. Pneumothorax is easily detected by conventional radiographs in the upright patient; when supine, the air collects in the anterobasal regions and particular projections are required; CT can reveal small amounts of air and is recommended in critically ill or trauma patients.

Plasma lipids, apoprotein A-I and B in serum and in lipoprotein fractions (VLDL + LDL, HDL2, and HDL3) obtained by preparative ultracentrifugation, as well as postheparin lipoprotein lipase activity (H-TGL and LPL) were evaluated in 17 subjects with primary biliary cirrhosis (stage II and III) subdivided into two groups according to the presence or absence of lipoprotein X (Lp-X). A reduction in total lipoprotein lipase activity was observed in both patient groups, compared to controls (P less than 0.01); the hepatic lipoprotein lipase was significantly reduced (P less than 0.01) only in the Lp-X-positive group. The lipid (477.8 +/- 154.3 vs 239.6 +/- 51.1; P less than 0.01) and protein (147.4 +/- 37.1 vs 83.3 +/- 19.7; P less than 0.01) masses in the VLDL + LDL fraction of the Lp-X-positive group were increased compared to controls. In the same group, the HDL2 fraction also showed an increase in lipid (186.6 +/- 80.0 vs 77.9 +/- 21.6; P less than 0.01) and protein (133.9 +/- 60.0 vs 67.9 +/- 16.5; P less than 0.01) masses; in addition, the HDL2 percent lipid composition was different in the two patient groups, showing a decrease in esterified cholesterol (20.4 +/- 3.6 vs 25.7 +/- 2.2; P less than 0.01) and an increase in phospholipids (59.2 +/- 2.9 vs 54.8 +/- 2.6; p less than 0.01) in the Lp-X-positive group.(ABSTRACT TRUNCATED AT 250 WORDS)