Search

Funding Acknowledgements Type of funding sources: None. Introduction Optimal venous access is crucial in successful cardiac device implantation. Most commonly used accesses are subclavian or axillary vein puncture and cephalic vein cutdown. The extrathoracic access has the advantage of reducing the risk of pneumothorax and lead disfunction; thus, this approach is recommended as the first choice approach. Purpose The aim of our retrospective registry was to evaluate the incidence of long-term device complications (pneumothorax, lead rupture or displacement, hematoma, infection or bleeding) with different venous approaches in four high-volume centers in Italy. Methods We collected data from implantation and device complications during follow up using available electronic records from each center. Results We included 4443 patients, mean age 73±11 years. Median follow up was 118 months (IC range 59-198 months). The incidence of any complication was 7.7 %, without difference between intrathoracic and extrathoracic access (7.8% vs 7.7% respectively, p=0.70). However, lead rupture was more frequent in the intrathoracic group (5.3% vs 1.4%, p=0.04). Conclusion In experienced, high-volume centers, the use of intrathoracic vein puncture in the case of unsuitable extrathoracic access may represent a safe alternative of venous access in patients undergoing cardiac device implantation, although associated with a higher occurrence of lead rupture.

Clinical Case We report the case of a 84–year–old female patient suffering from post–infarct heart disease with severe systolic dysfunction, wearing a dual–chamber defibrillator in secondary prevention because she had previously presented an episode of monomorphic ventricular tachycardia. After the implant, the patient was enrolled in the remote monitoring service of the device and constantly followed by our team. After a few months, at the remote control we found repeated episodes of very short duration of an alarm recognized by the device as ventricular arrhythmia in the VF window. Contrary to the arrhythmic interpretation of the device, the analysis of the EGM by the medical and nursing staff highlighted an electromagnetic interference defined by the type of signal, the presence of the same in all channels and by the lack of correlation with the underlying heart rhythm. The sensing of the ventricular lead was 5–6 mV, at the lower limits but stable over time, the other parameters were optimal. The patient was promptly contacted and questioned about the circumstances and symptoms: she was asymptomatic and we found that the interference came in conjunction with the use of a cordless telephone. The alarm was related to the electromagnetic field generated by the phone and the woman was asked to stop using the device with subsequent absence of device alarms. Electromagnetic interference in defibrillators can be a cause of potentially serious inappropriate therapies (ATP, pacing and shock), the analysis and correct interpretation of the EGM by the clinician is essential for the prevention of the same. Thanks to the efficiency of the remote monitoring service, the risk of serious consequences for our patient was avoided. Subsequently the lead was repositioned due to a worsening of the sensing, but even before the re–intervention there was no longer any false alarm thanks to the absence of the environmental source of interference. The remote monitoring service applied to implantable defibrillation systems is a valuable tool for identifying lead problems or, as in this case, environmental problems, and toprevent, thanks to rapid intervention, further potentially serious complications.

We report the case of a 83–year–old male who underwent single chamber pacemaker implantation in another center for bradyarrhythmia (atrial fibrillation) symptomatic for syncope. A ventricular lead was implanted in the apical septum, the post–procedural posterior–anterior chest radiograph showed correct placement of the leads and generator. Approximately 4 months after the implant, the patient came to our observation for repeated electric pulsations in his left shoulder. The patient was affected by mild dementia and was asymptomatic except for the presenting symptomatology, in particular he denied a history of syncope. The ECG showed arrhythmia due to atrial fibrillation, ventricular undersensing, and lack of ventricular capture (Figure 1). The chest X–ray showed the complete dislodgement of the ventricular lead tip apparently into the vein secondary to the rotation of the pulse generator on its transverse axis with consecutive coiling of the lead (Fig. 2). These findings were consistent with Reel syndrome The patient was admitted to undergo a lead repositioning attempt in consideration of the recent first implant. During the surgery, however, it was shown that the lead was completely displaced from the venous system, near the pectoral muscle. This extreme dislocation of the lead has been related to the electric pulsations felt by the patient. We proceeded with a new re–implantation of the lead and removal of the previous one. The lead was firmly tied to the pectoral muscle with 2 silk points with slight traction control of optimal fixation. Reel‘s syndrome is a variant of the better known Twiddler syndrome, characterized by the coiling of catheters along the transverse axis of the pacemaker. It is often a complication due to the manipulation of the generator by the patient, unlike Twiddler syndrome it occurs early and the leads remain intact. This syndrome is one of the most serious complications of pacemaker or defibrillator implants, it can be potentially fatal due to lack of therapy in the case of defibrillators, or asystole in pacemaker–dependent patients.

The human immunodeficiency virus (HIV) causes an infectious disease with a high viral tropism toward CD4 T-lymphocytes and macrophage. Since the advent of combined antiretroviral therapy (CART), the number of opportunistic infectious disease has diminished, turning HIV into a chronic condition. Nevertheless, HIV-infected patients suffer from several life-long symptoms, including the HIV-associated neurocognitive disorder (HAND), whose biological substrates remain unclear. HAND includes a range of cognitive impairments which have a huge impact on daily patient life. The aim of this study was to examine putative structural brain network changes in HIV-infected patient to test whether diffusion-imaging-related biomarkers could be used to discover and characterize subtle neurological alterations in HIV infection. To this end, we employed multi-shell, multi-tissue constrained spherical deconvolution in conjunction with probabilistic tractography and graph-theoretical analyses. We found several statistically significant effects in both local (right postcentral gyrus, right precuneus, right inferior parietal lobule, right transverse temporal gyrus, right inferior temporal gyrus, right putamen and right pallidum) and global graph-theoretical measures (global clustering coefficient, global efficiency and transitivity). Our study highlights a global and local reorganization of the structural connectome which support the possible application of graph theory to detect subtle alteration of brain regions in HIV patients.Clinical Relevance-Brain measures able to detect subtle alteration in HIV patients could also be used in e.g. evaluating therapeutic responses, hence empowering clinical trials.

In the Anthropological and Ethnographical Museum of University of Cagliari are custodied two mummies, a male and a female one. Subjected to autopsy in 1895, the latter is wrapped by mystery. It is considered she could be a victim of a murder. In the light of modern techniques of inquiry, a multidisciplinary team of research tries to throw light on some main aspects: • The woman’s age • The reasons of death • The causes of mummification The achieved data are compared with those reported in the account of the autopsy, published by Gaetano Corrado in 1899.

Herein we report clinical and virological data in a patient with COVID-19 infection and a prior history of kidney transplantation who had a good clinical recovery despite systemic infection.Reverse transcriptase quantitative PCR analysis for the RdRp, N and E target genes detected viral RNA in different types of biological specimens. Whole viral genome sequences were obtained and analyzed from respiratory tract, feces and blood.Viral sequences showed high (~99.9%) homology with the Wuhan seafood market pneumonia virus. Phylogenetic analysis assigned of the SARS-CoV-2 strains to clade G. A rare variant in the orf1ab gene was present in both sequences, while a missense variant was detected only in viral RNA from stool.The evolution of the COVID-19 systemic infection in the patient presented here was favorable to the hypothesis that immunosuppressive therapy in organ transplant recipients might be involved in viral dissemination. A missense mutation was present in only one specimen from the same patient implying the occurrence of a mutational event in viral RNA, which is suggestive for the presence of an active virus, even though viral isolation is necessary to demonstrate infectivity.

BackgroundInterstitial lung disease (ILD) in Rheumatoid Arthritis (RA) can be subclinical or underestimated. Data from the literature report male sex, seropositivity and old age as known risk factors for ILD in RA. However, the correct timing for referral to pneumologists and eligibility for CT chest scan is undefined.ObjectivesTo identify potential red flags of ILD diagnosis for referral to a multidisciplinary team analyzing clinical and radiological findings associated with the establishment of ILD.MethodsRetrospective study on CT chest scan from RA patients evaluated and categorized into usual interstitial pneumonia (UIP), nonspecific interstitial pneumonia (NSIP) and unclassifiable RA-ILD (Un-ILD), by two radiologists. RA-ILD was diagnosed by two pneumologists considering radiological and clinical factors.Results80 CT chest scans from RA patients (F 59, age 66,6 ± 11,4, disease duration 7,8 ± 4,4) were evaluated. 36,5% of patients had performed CT-chest scan for suspect of ILD, 11,2% for probable pulmonary infection, 8,7% for oncological screening or follow up, 13,7% for COPD disease, 8,7% for screening or active TBC, 3,7% for screening or previous pleuritis and 17,5% for other reasons. A RA-ILD pattern was identified in 35% of patients, with a defined UIP pattern in 17,8%, a defined NSIP pattern in 42,8% and a 39,3% of Un-ILD, while 65% of patients had a non-ILD lung involvement by CT-scan. The mean age at ILD diagnosis was 67,2 years and the mean time between RA diagnosis and onset of ILD symptoms was 7,4 years.In the multivariate analysis female sex (HR=0,33; p=0,006) and disease duration (HR=0,8; p=0,06) were protective factors for ILD diagnosis. Age (HR=1,1; p=0,03), use of leflunomide (HR=10,1; p=0,03) were negative prognostic factors for ILD. Pulmonary clinical symptoms as dry cough (HR=17,6; p=0,02), bibasilar inspiratory crackles (HR=11,5; p=0,01) and pleural rubs (HR=18,1; p=0,03) predicted ILD while negative predictors were the presence of linear opacities (HR=99,9; p=0,006), interstitial abnormalities (HR=12,1; p=0,07) and cystic areas (HR=33,3; p=0,06) at chest CT scan.ConclusionIn our cohort the first ILD symptom appeared 7.4 years after RA diagnosis. Clinical variables and radiological abnormalities were identified as highly predictive of ILD diagnosis and may represent red flags for an early diagnosis and referral to pneumologists and radiologists in a multidisciplinary approach.Disclosure of InterestsNone declared

To understand and mitigate the role of surface water composition and associated membrane fouling in the removal of nC60 nanoparticles by low-pressure membranes, experiments were carried out with microfiltration membranes using natural feed waters, mimicking separation in real industrial water treatment plants. The effects of water composition, the presence of nanoparticles, and membrane fouling were investigated with a dead-end bench-scale system operated under constant flux conditions including a hydraulic backwash cleaning procedure. nC60 nanoparticles can be efficiently removed by microfiltration and the removal efficiency is found to be independent of the water surface composition. However, the water composition controls the extent of fouling occurring during filtration. A synergistic effect on membrane fouling between nC60 and surface water constituents such as natural organic matter (NOM) and its fractions is observed: the synergistic effect resulted in a transmembrane pressure (TMP) increase always higher than the sum of the TMP increase due to the filtration of nC60 in ultrapure water and the TMP increase due to the surface water without nC60.

In 1953, during the building restoration of San Michele church (Bono, Sardinia, 16th-19th Century), a high number of disarticulated skeletons were recovered. From a group of 412 hip bones, two of these, affected by several pathological lesions, were analysed. The two coxal bones can be referred to the same individual, an adult man. A multi-analytical study, started with the purpose of investigating the bone pathology, was extended to characterize the mineral components of a large representative set of bones from the same ossuary, all attributed to adult men who lived in the region four-two centuries ago. A quantitative ICP-AES analysis for Ca, Fe, Mg, Mn, Na, Pb and Zn was executed, and a chemometric investigation on the results was performed. This approach gave evidence of the effects of diagenesis, allowed some hypothesis of the incidence of the known dietary habits on bone composition, and completely differentiated the pathological bones from those of a normal population on the basis of the mineral composition. Moreover, porosity, crystallinity and FT-IR analysis were conducted on both non- and pathological sample.

The Osteological Collection described in this paper is located at the Anthropology Laboratory annexed to the Sardinian Museum of Anthropology and Ethnography of the University of Cagliari. It has been created in 1953 by Carlo Maxia and comprises a large number of skeletal remains. At present the Collection consists of 11,854 human bones and continues to grow. The remains belong to different periods, beginning from the Early Neolithic and continuing to the Modern Age. The aim of this work is to provide information on the composition of this collection after the reorganization carried out in the last years.

This paper presents a set of validation experiments for the reconstruction of a cross-sectional particle concentration field in a transparent pipe filled with a fluid using optical tomography.

Theories describing the turbulent deposition of particles from aerosols have recently been applied to drinking water distribution. In order to allow the study of these processes in a quantitative way and internally observe a cloud of suspended particles in a pipe, we have developed an optical tomography technique and measuring device using low cost electronic components specifically for this application. The mathematical methodology and the electronic device are described in this paper, and tests of both the mathematical approach and the actual device are presented. We conclude that the mathematical framework presented is suitable and that the technical implementation works in a test setting. The described methodology may provide a valuable tool for the study of processes related to drinking water discolouration in the lab.

Bovine Albutensin (BA) and human Albutensin (HA) represent f (208–216) of bovine serum albumin (BSA) and f (210–218) of human serum albumin (HSA), respectively. The release of BA and HA was studied during tryptic digestion of serum albumins in solutions at different pH values. Specific release of either BA or HA was achieved by tryptic hydrolysis of serum albumins in 0.1 m NaH 2 PO 4 solution adjusted to pH 3.5. Under these conditions, about 29–50% of the theoretical maximum of BA and 18–23% of the theoretical maximum of HA were released at high purity after 18 h digestion. Heat treatment of BSA (90 °C for 1–60 min) prior to tryptic hydrolysis (pH 3.5) did not improve the release of Albutensins. Under the same heating conditions, Albutensin from either BSA or HSA proved to be stable. Tryptic hydrolysates at pH 3.5 of serum albumins were submitted to simulated gastro-intestinal digestion. BA and HA were stable under peptic hydrolysis whilst they were almost completely hydrolysed by Corolase PP™.

The potential environmental and health risks of engineered nanoparticles such as buckminsterfullerene C60 in water require their removal during the production of drinking water. We present a study focusing on (i) the removal mechanism and (ii) the elucidation of the role of the membrane pore size during removal of nC60 fullerene nanoparticle suspensions in dead-end microfiltration and ultrafiltration mimicking separation in real industrial water treatment plants. Membranes were selected with pore sizes ranging from 18 nm to 500 nm to determine the significance of the nC60 to membrane pore size ratio and the adsorption affinity between nC60 and membrane material during filtration. Experiments were carried out with a dead-end bench-scale system operated at constant flux conditions including a hydraulic backwash cleaning procedure. nC60 nanoparticles can be efficiently removed by low pressure membrane technology with smaller and, unexpectedly, also by mostly similar or larger pores than the particle size, although the nC60 filtration behaviour appeared to be different. The nC60 size to membrane pore size ratio and the ratio of the cake-layer deposition resistance to the clean membrane resistance, both play an important role on the nC60 filtration behaviour and on the efficiency of the backwash procedure recovering the initial membrane filtration conditions. These results become specifically significant in the context of drinking water production, for which they provide relevant information for an accurate selection between membrane processes and operational parameters for the removal of nC60 in the drinking water treatment.

Malignant autosomal recessive (AR) osteopetrosis represents an absolute indication for bone marrow transplantation (BMT). Over the last 15 years, almost 100 BMTs for osteopetrosis have been reported. The median age at transplant of most patients is 4 months. Very few cases of mild AR osteopetrosis have been described. Here, we report the good outcome of two cases of mild AR osteopetrosis with a follow-up of 5 and 6 years, respectively, after an HLA-identical sibling transplant undergone at 5 and 12 years of age, respectively. At the time of BMT, severe visual impairment was present in both children. Bone biopsy demonstrated hypermineralization with virtual obliteration of the medullary spaces, rare microfoci of hematopoiesis and marked deficiency in osteoclastic activity. Successful engraftment was complicated by hypercalcemia, controlled by a combination of bisphosphonate, phosphate infusions, vigorous hydration and calcitonin. Following BMT, radiological and histological findings showed extensive bone resorption with marked augmentation of the osteoclasts in normalized marrow. No improvement was observed in visual acuity, despite complete remodeling of skeletal abnormalities. We conclude that allogeneic BMT is the only chance of curing mild AR osteopetrosis.

Several transport mechanisms govern the cross-sectional particle distribution in fully developed turbulent flow in a pipe. These transport mechanisms affect particle load deposition as well as particle resuspension, which are identified as principal protagonists in the build-up of potential discolouration risk in drinking water distribution systems (DWDS). Both are to a large degree controlled by particle size and flow conditions. However, so far, these relationships are not completely understood in the context of DWDS. In this research we have attempted to identify under which conditions particles suspended in water are transported towards the pipe wall, which generate favourable conditions for deposition. Experimental results are reported and then compared, qualitatively and quantitatively, to the theoretical predictions in the regime transport map for turbulent flow proposed by van Thienen et al. (2011a). The research was conducted by completing a series of experiments in a laboratory test facility with different hydraulic regimes and different particle size ranges. A newly developed optical tomography measurement system was used in order to produce cross-sectional images of particle concentration in water flowing inside a pipe. The experimental results allowed us to identify flow conditions and particles sizes under which gravitational settling and turbophoresis dominated the radial particle transport. These findings show a good correspondence between experimental data and theoretical predictions on the occurrence of turbophoresis and lead to a better understanding of the processes that increase the potential discolouration risk in DWDS.

Diaphragma sellae meningiomas represent a difficult challenge for neurosurgeons; they are generally operated on by a transcranial approach. Some authors reported transsphenoidal surgery in selected cases, but without accurately focusing the surgical technique that should be necessary for removing the typical hard fibrous tissue of the meningioma, that is not aspirable, by this approach. We present the surgical technique and the useful instrumentarium for removing a diaphragma sellae meningioma through an extended microsurgical transsphenoidal approach.

Infant food is basically specialty nutrition with highly-balanced composition aimed at mimicking breast milk, the golden standard, as closely as possible. The baby food industry nowadays offers a wide range of products trying to fulfill the changing needs of newborns and young children in their early stages of life. Cows’ milk is the starting material of most infant food products and differs in many aspects from human milk. Humanization of infant formula therefore receives great attention. Adapting the casein-whey protein ratio and increasing the α-lactalbumin content (reducing the β-lactoglobulin content) are amongst the most obvious changes that need to be made in the final formula composition. Allergy to cows’ milk is one of the possible negative effects of infant formula that can be overcome by applying hypoallergenic bovine protein hydrolysate, for which new technologies are developed to optimize taste and allergenicity. It is realized that minor components such as oligosaccharides, nucleotides, proteins and peptides have an important function in mothers’ milk and therefore technologies are developed to obtain biologically active ingredients such as bioactive peptides. Processing technologies, used to ensure the highest microbial quality of infant food, have great impact on the individual ingredients. Therefore new processing technologies such as ultra high temperature ultra short-time heating technologies and high-pressure technologies are developed and evaluated. This chapter deals with various aspects of developments of new ingredients and technologies to improve infant food.

Four Sardinian population samples, from the provinces of Cagliari, Oristano, Nuoro and Sassari, were studied with regard to the erythrocyte enzyme systems ACP, ESD, PGM1, ADA, AK, 6PGD and Dia, and to the serum protein systems GC and C3. The findings showed a rather high degree of genetic heterogeneity of the Sardinians compared to the other populations from the Mediterranean area (Continental Italy, Sicily, Spain, North Africa).

Background/Aims: As evidence accumulates relating to mother-to-child (vertical) transmission of hepatitis C virus (HCV), it is timely to draw up guidelines for the clinical management of HCV infected pregnant women and their children. Methods: A review of evidence from the European Paediatric HCV Network (EPHN) prospective study of HCV infected women and their children and other published studies. Meeting of EPHN clinical experts to reach a consensus on recommendations for management. Each recommendation was graded according to the level of evidence. Results/conclusions: Although several risk factors for mother-to-child transmission have been identified, none are modifiable and there are currently no interventions available to prevent vertical transmission of HCV. Data on timing of loss of maternal antibodies and reliability of diagnostic tests inform the optimum follow-up schedule for confirmation or exclusion of infection in children born to HCV infected women. Based on the current evidence, routine antenatal screening for HCV should not be introduced and neither elective caesarean section nor avoidance of breastfeeding should be recommended to HCV infected women to prevent mother-to-child transmission of HCV. HCV/HIV co-infected women should follow existing HIV guidelines. © 2005 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

To investigate whether it is appropriate to assume comparability of hepatitis virus C (HCV)-RNA results across laboratories in multi-centre studies, nine laboratories of the European Paediatric HCV Network participated in an international proficiency study of HCV-RNA assays. A panel of 12 samples of different dilutions and genotypes was sent to each laboratory and tested with qualitative and/or quantitative HCV-RNA assays according to local procedures. Commercial assays were used in seven laboratories and in-house assays in two. All six laboratories in which a commercial qualitative assay was used were proficient, as were four of six runs (in five laboratories) in which a commercial quantitative assay was used. The proficiency of the laboratories where in-house assays were used could not be assessed according to the VQC definition because of differences in the methods used. Overall, there were several false-negative results, but only one false-positive result with a quantitative assay and none with a qualitative assay. The false-negative results may have implications for the diagnosis of infection, and highlight the need for an antibody test to be performed at 18 months to confirm the absence of infection. The results of qualitative assays were generally consistent across laboratories but it was difficult to evaluate and compare the results of quantitative assays. Multivariate analysis of data collected in multi-centre studies should therefore allow for centre and/or assay used. © 2003 Wiley-Liss, Inc.

Allogeneic bone marrow transplantation (BMT) is a widely accepted therapeutic approach in homozygous beta-thalassemia. However, the majority of patients do not have a genotypically identical donor within the family. This prompted us to conduct a pilot study to investigate the feasibility of matched unrelated bone marrow transplantation in thalassemia. The major drawback was the high risk of immunologic and transplant-related complications, mainly graft-versus-host disease (GvHD) and graft failure.Our aim was to reduce this risk through careful selection of donor/recipient pairs. HLA haplotypes that show a high linkage disequilibrium among their class I, class II and class III alleles are considered extended or ancestral haplotypes.These haplotypes are conserved and can be shared by apparently unrelated individuals. Our study shows that matching for these haplotypes significantly improves the outcome of unrelated bone marrow transplantation in thalassemia. In fact, results were comparable to those obtained in transplants using HLA-identifical family donors.Better results were obtained in patients with lesser iron overload and when the donor shared an identity for the DPB1 alleles.

The aim of the study was to compare gadolinium-enhanced MRA (Gd-MRA), Computed Tomography angiography (CTA) and digital subtraction angiography (DSA) in the evaluation of carotid stenosis.Thirty patients with US-proven internal carotid artery stenosis over 50%, underwent Gd-MRA, CTA and DSA. Gd-MRA was acquired using the keyhole technique.The overall agreement was 90% for Gd-MRA and 93% for CTA. Gd-MRA and CTA overestimated 5 and 4 cases of mild stenosis and 1 case each of moderate stenosis, respectively. Gd-MRA better delineated ulcerated plaques, tandem lesions and pseudo-occlusions.Because of the high speed acquisition breath-hold is no longer necessary for Gd-MRA and more delayed phases were analysed when necessary. The main limitation of Gd-MRA was represented by insufficient volume coverage that allowed the visualisation of supraaortic vessels from the arch only in 57% of the cases. Calcified plaques were very well detected by CTA and not by Gd-MRA. In our experience Gd-MRA represents the second step non invasive tool in patients with US-proven carotid stenosis. This leads to avoid conventional angiography in most cases.

To evaluate the efficacy of diffusion weighted Magnetic Resonance Imaging in the diagnosis of acute ischemic infarction and correlate the signal changes observed in the acute phase with final brain damage.Fifteen patients (six women and nine men: mean age 68 years) with acute ischemic stroke (within 12 hours) underwent diffusion MRI. All the patients were selected on the basis of sudden focal neurologic symptoms and CT findings excluding other conditions than ischemia. MRI was performed with a 1.5 T magnet with echo-planar gradients. All the patients underwent follow-up CT and/or MRI.Diffusion MRI, performed in the acute phase, showed signal changes in all the patients whose infarction was later confirmed by CT or MRI. In 10 of 12 patients with positive diffusion imaging, CT was normal. FLAIR sequences showed the lesions in 4 of 12 cases. In the 2 patients with transient ischemic attack diffusion MRI was normal as well as follow-up examinations. Apparent Diffusion Coefficients values in the infarcted area were almost half those of the contralateral normal brain. Final damage (as assessed by CT or MRI) was larger than observed in acute diffusion images in all cases but one.Because of its high sensitivity and specificity, diffusion MRI is going to play a more important role in the management of acute ischemic stroke patients.

Some clinical trials (NASCET, ECTS) have assessed that carotid endarterectomy is protective against stroke in patients with asymptomatic severe carotid stenosis. In order to decrease costs and risks, new diagnostic tools have been developed, such as Magnetic Resonance Angiography (MRA), duplex Ultrasound (US) and more recently Spiral Computed Tomography Angiography (CTA). CTA provides excellent 3D angiography images of the extracranial vessels using a volume rendering technique. This study was aimed at prospectively evaluating the accuracy of CTA in the diagnosis of carotid bifurcation. The circle of Willis was also studied during the same bolus injection. DSA was used as the gold standard technique. Surgery was also used for comparison.Spiral CTA and DSA were performed in 106 carotid bifurcations. DSA was performed in all patients within 48-72 hours of CTA. The degree of internal carotid stenosis was evaluated according to NASCET criteria. Degree of stenosis, presence of calcifications, ulcerations and tandem lesions were reviewed by two different neuroradiologists blinded to each other and to the results of the other technique. In 19 cases the size of residual lumen of the ICA was surgically evaluated and correlated with CTA.There was an overall correlation between CTA and DSA in 94% of cases. Our data are in agreement with the results of the current literature. CT angiograms overrated by one category 6 cases (25%) of mild and one of moderate stenosis (7.14%). Calcifications were seen on spiral CT angiography in 69 (65.09%) carotid bifurcations while DSA detected the presence in 31 (29.24%). Ulcerations were missed by CTA in 3 cases. Five (4.71%) tandem lesions were visualized by DSA distal to bifurcation: 2 (1.88%) were also diagnosed by CTA. The patency of the circle of Willis was assessed in all cases. In 19 cases, the size of ICA stenosis evaluated at surgery was comparable with CTA findings.In conclusion CTA offers an outstanding alternative to catheter angiography in the evaluation of stenosis-occlusion of the carotid bifurcation. The intracranial circulation can be easily assessed by CTA as well, which allows the study of tandem lesions and of the circle of Willis.

In the past few years, non-Hodgkin's lymphomas have been paid increasing attention to because of their recently increasing frequency. We reviewed the MR images of 17 patients with histologically proved primary CNS lymphoma, all of them immunocompetent at diagnosis. We studied the site, number and shape of the lesions, the presence and grade of edema and possible periventricular spread. The exams were performed with 0.5 T and 1.5 T MR units, using SE sequences on the sagittal, axial and coronal planes, before and after Gd-DTPA administration. The most typical neuroradiologic signs which may suggest the diagnosis of CNS lymphoma are deep or periventricular lesion site, diffuse and marked contrast enhancement, poorly defined borders, moderate edema surrounding the mass and a tendency to periventricular spread. MRI demonstrated 35 lesions in 17 patients. The lymphoma was unifocal in 9 cases (53%) and 7 lesions were localized in subtentorial site. Lesion size did not exceed 2 cm in 49% of cases, ranged 2-4 cm in 40% and exceeded 4 cm in 11% of cases only. These lesions and hypo- to isointense on T1-weighted images (97%) and their signal intensity varies on T2-weighted images, with mainly iso-/hypointense patterns (79%). All lesions enhanced after Gd-DTPA administration, 74% of them markedly and 26% moderately; enhancement was mostly homogeneous (80% of cases). Perilesional edema was observed in 74% of cases. In conclusion, MRI yields some useful information for the diagnosis of primary CNS lymphoma, but the clinical and radiologic signs of this lesion may exhibit aspecific signal features, meaning that no correct diagnosis can be made even in immuno-competent patients.

PURPOSE: To define MR accuracy in the evaluation of the T stages of tumors of the tongue and floor of the mouth. METHODS: Fifty-two patients affected by squamous cell carcinoma were studied with a superconductive system at 1.5 T. The study was performed with spin-echo T1- and T2-weighted images before contrast and short spin-echo T1-weighted and gradient-echo sequences after gadopentetate dimeglumine administration. The results obtained with MR were compared with pathologic data. RESULTS: Good correlation of T stages (TNM system) was obtained in 45 of 52 cases. MR did not show four superficial lesions. In one case, infiltration of the cortical bone of the mandible was not demonstrated (MR, T2; pathologic, T4), and in another the lesion was classified as T2 instead of T3, as it was pathologically. One lesion was classified as T4 on MR because of infiltration of the alveolar ridge but was classified as T2 at surgery. In 46 patients who underwent surgery, the accuracy of MR was excellent for predicting the relationship of tumor to midline and oral floor musculature. The results obtained with gadopentetate dimeglumine were better than those obtained in noncontrast studies in 32 (62%) of 53 cases. CONCLUSION: MR showed high accuracy in the study of tumors of the tongue and floor of the mouth.