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Purpose: The continuous discovery of new subtypes of neuromuscular disorders demands more accurate imaging analyses. We set out to establish the specific patterns of muscular involution using magnetic resonance imaging (MRI)., Materials and Methods: A systematic clinical evaluation based on the Medical Research Council scale and MRI was completed in ten patients with calpainopathy [limb-girdle muscular dystrophy (LGMD)-2A], 16 with dysferlinopathy (LGMD-2B), ten with hyaline body myopathy (HBM), six with myotonic dystrophy (MD) types 1 and 5 with MD type 2. Severity of fibroadipose degeneration was specifically staged using T1-weighted sequences. Turbo inversion recovery magnitude (TIRM) sequences were used to assess oedema-like changes., Results: T1 scans showed recurrent patterns of fibroadipose replacement, whereas TIRM images revealed differences in oedema-like changes between the various diseases. In LGMD, the posterior compartments are more vulnerable to degeneration. In HBM, fatty muscle degeneration and oedema are allocated to muscles of the posterior compartments of the leg. In MD, fatty muscle degeneration and oedematous changes are allocated to muscles of the anterior thigh and posterior lower leg., Conclusions: Imaging examination suggests a characteristic pattern of muscle involvement. MRI represents an important diagnostic technique useful in differential diagnosis, thanks to the distinctive patterns observed in the distribution of muscular changes between the different muscular diseases.

Purpose: Surgery of recurrent carotid stenosis (RCS) has higher complication rates than primary carotid endoarterectomy (CEA). Percutaneous transluminal angioplasty (PTA) and stent placement were evaluated retrospectively with a view to proposing then as alternative procedures for RCS., Methods: In the last 10 years, 19 patients underwent 20 endovascular procedures for RCS at our Department. The mean interval between CEA and PTA was 21 months (range 4-96): 14 patients had PTA within 2 years, 3 patients within 2 and 3 years,and 2 after 3 years. The mean degree of stenosis was 92% (range 80-95%). PTA was performed by balloon catheters (size 4-7 mm) without using cerebral protection device; one self-expanding stent was used to treat RCS after PTA. All patients underwent physical examination and carotid color-coded Doppler sonography in autumn 1999, Results: The procedure was technically successful, with residual stenosis lower than 50%, in 17 of 19 patients; 10 patients showed residual stenosis lower than 30%. Carotid PTA was stopped due to transient neurological deficit in one case. One RCS proved uncompliant even though high-pressure balloon catheters were used. The mean follow-up period in 16 patients was 37.4 months (range 3-99 months). Carotid restenosis after PTA developed in 3 patients, respectively after 29,18 and 7 months. In the last case RCS was successfully treated by stent placement (Wallstent). The primary patency rate was 81%, the secondary patency rate was 88% and the late clinical success rate was of 94%., Conclusions: In selected cases, PTA without the use of cerebral protection devices and stent placement proved to be a safe and effective alternative treatment for early RCS. When an atherosclerotic lesion is suspected surgery or endovascular treatment with cerebral protection devices are recommended.

We reviewed the long-term results of transcatheter arterial chemoembolization in the treatment of inoperable hepatocellular carcinoma (HCC) complicating cirrhosis; the survival analysis was used to assess the clinical efficacy of the procedure. Several chemoembolization protocols are discussed because no standard treatment exists. Literature data show cumulative survival rates after chemoembolization for an HCC to range 60% to 80% at one year and 40% to 50% at two years; comparative studies, although contradictory, show a trend of chemoembolization to prolong survival in patients with inoperable carcinoma. The main prognostic factors are tumor size and extent, liver function impairment, the grade of Lipiodol tumor uptake, and the tumor response to therapy. The complication rates of chemoembolization vary largely in the literature, mainly because of the different standards used to define adverse events. Chemoembolization morbility rate is usually high, ranging 20% to 55%, but most complications are generally well treated with conservative management. The mortality rate is usually very low and well acceptable for a palliative anticancer therapy. In conclusion, chemoembolization is clinically effective in prolonging survival in cirrhotic patients with HCC; the lack of any reliable alternative therapy makes chemoembolization play a major role in the treatment of HCC when surgery or percutaneous ethanol injection are unfeasible.

Purpose: To investigate clinical value and tumor response of preoperative transcatheter arterial chemoembolization for hepatocellular carcinoma (HCC) secondary to cirrhosis., Materials and Methods: The clinical, radiologic and histologic findings were reviewed relative to 13 cirrhotic patients operated on for HCC after chemoembolization with an emulsion of Lipiodol UF and epirubucin; additional gel-foam embolization was performed in 12 cases., Results: The mean survival was 24 months. Three patients died within 1 month after surgery; 2 other patients died 10 and 32 months after surgery, respectively. The 2-year recurrence rate was 40%. Tumor size, the grade of iodized oil retention and the embolization technique affected primary tumor necrosis ratio: most of satellite nodules and capsular invasions were persistently viable at histology., Conclusions: Preoperative chemoembolization neither facilitates, nor contraindicates, HCC surgery. Nevertheless, chemoembolization should always be performed before surgery first to stage the patients with Lipiodol CT and second to administer the first palliation whenever the patient is ineligible for surgery.

The average patency time after creating an endogenous arteriovenous Brescia-Cimino fistula for hemodialysis is limited. May 1990 through October 1992, 29 PTAs were performed in 23 patients with malfunctioning hemodialysis Brescia-Cimino fistulas of the forearm, by cannulation of the venous anastomotic branch and by balloon catheter dilatation. Thirty-six venous stenoses, 7 arterial anastomotic stenoses and 1 venous occlusion were treated. In 5 patients a second dilatation became necessary due to recurrent fistula malfunction after a mean period of 5 months. Twenty-eight of 29 PTAs (96%) were immediately successful. The primary patency rates were 79% at 6 months, 61% at 1 year and 61% again at 2 years. The secondary patency rates were 90%, 83% and 83%, respectively. Three post-PTA fistula thromboses (10%) were observed: two of them were successfully treated by local fibrinolysis while in the extant case a new A-V shunt was created. In our opinion, PTA is the treatment of choice for malfunctioning Brescia-Cimino fistulas; the incidence of complications was low in our series.

The data relative to 13 years' experience with percutaneous transluminal renal angioplasty (PTRA) in the 13 major interventional radiology centers in Italy were collected and analyzed to evaluate technical and clinical results. Our aim was to collect homogeneous results in a large series of patients, evaluating both the technical and the clinical success with a long-term follow-up (1 month-13 years). One thousand three hundred forty seven PTRA procedures (including 42 restenoses) in 1,073 patients were retrospectively reviewed. In 807 cases the cause of stenosis was atherosclerosis, in 442 cases fibromuscular dysplasia and in 24 cases arteritis in 12 cases, stenoses were present in patients that had undergone a surgical by-pass. Sixty-two stenoses in patients with solitary kidney and 102 in patients with renal failure were studied separately. The technical success (based on the morphology of the dilated tract) obtained in 91% of cases was considered, together with the clinical success (in 81% of cases), based on the decrease in blood pressure evaluated according to Martin's classification. The blood pressure values collected after the maneuver were also evaluated separately for the different types of stenosis etiology: atherosclerosis, fibromuscular dysplasia or arteritis; moreover, blood pressure was studied in solitary kidney patients and in those with renal failure. Complications were classified as major (4.2%) and minor (4.9%). The high success rate and the low incidence of complications we observed in our series suggest PTRA as the procedure of choice for high blood pressure patients with renal artery stenosis > 50% of the normal caliber.

This study was aimed at evaluating the efficacy of chemoembolization (CE) to improve survival in patients with hepatocellular carcinoma (HCC). Our results were compared with the natural history of HCC. Sixty-two consecutive patients with HCC in Okuda's stages I and II underwent CE. Forty-seven patients were treated with CE alone; 9 patients had CE prior to surgery, and 6 patients had it after surgery because of recurrent HCC. One hundred and nine CEs (mean: 1.8 CEs/patient) were performed with Lipiodol UF, epirubicin and gelatin sponge. Actuarial survival was calculated considering Okuda's stage, neoplasm size, and evidence of pseudocapsule. The mean cumulative survival of the 47 patients treated with CE alone was 13.2 months; survival (+/- SE) at 12, 24 and 36 months was 0.75 (+/- 0.07), 0.46 (+/- 0.10) and 0.28 (+/- 0.12). Survival was not affected by Okuda's stage, neoplasm size, evidence of pseudocapsule (p > 0.05). Nevertheless, the patients with early HCC had better prognosis. Eighteen patients (42.9%) died during follow-up, 12 of whom (66.7%) from hepatic failure. The mean survival of patients with recurrence of HCC after surgery was 41 months (range: 24.8-74.9 months) since initial diagnosis of HCC, and 14.8 months (range: 7.1-29.6 months) since diagnosis of recurrence. Two of these patients died from hepatic failure. All the patients who underwent also surgery after CE are still alive (mean survival: 14.7 months). Histologic findings of resected specimens revealed viable neoplastic cells in all cases. Twenty-one major complications (20.2%) occurred in 18 patients (29%); the outcome of complications was favorable in all but one patient who died from sepsis. CE is a reliable and safe treatment for unresectable HCC. Small HCCs should be preferably treated with surgery or, alternatively, with percutaneous alcohol injection.

The authors consider their early results in radiological drainage management of abscesses and fistulas complicating abdominal surgery by integrated use of angiographic materials and interventional methods. Twenty-five patients, affected by isolated (32%) or communicating (68%) abscesses, were treated. Cavity obliteration and clinical recovery were obtained in 18 patients (72%), partial success in 1 (4%); a patient was treated unsuccessfully. Five patients were not evaluated because they died or underwent surgery again. Average drainage interval was 54 days. Drainage management was carried out by replacement of surgical catheters and fibrin occlusion. Fibrin occlusion was performed in 7 patients with the following results: 3 successes, one partial success and one failure. Two cases were not evaluated. Although a comparison with a control group was not performed, the authors consider the procedure a safe, economic and simple method for abdominal abscess management.

Preliminary results of attempts of pulmonary artery thrombi fragmentation after venous embolism are presented. Fragmentation is directly obtained by angiographic catheters (F 9 or 10). By this method we attempted to remove the block of some pulmonary branches, in order to obtain a perfusion of them and to improve fibrinolysis. This method is useful in patients who are not candidated for surgical embolectomy.

The radiologic findings are described of mucosal folds thickening in coeliac sprue in patients with short clinical history. Moreover attention is pointed on the flattening of the valves and the thinning of the intestinal walls which appear in dilated segments in cases with evident clinical findings. Finally in patients with long standing clinical manifestations and histologic positive controls, a thin spiculation of intestinal outlines and a dotted mucosal surface are visible, probably due to the filling of the Lieberkühn glands with contrast medium.

The authors, studying 72 abdominal aortic aneurysms by ultrasounds, show the main diagnostic problems of this pathology. These aneurysms are divided into two classes: the silent and the acute ones; the second group includes the atherosclerotic aneurysms in rupture and the dissecting aneurysms. Ecography is considered as a preliminar test in the evaluation of the aneurysms of the first group, allowing, in case of good results, the surgical operation without other invasive tests. Ultrasounds can also reduce problems of differential diagnosis. In case of non dissecting acute aneurysms, ecography leads to a quick diagnosis, allowing sudden surgery. In case of dissecting aneurysms, angiography remains the best examination, except those rare cases with atypical symptoms.

The authors expose the CT findings of primitive hepatic neoplasms. There are emphasized the usefulness of CT in detecting hepatic tumors and in the evaluation of its extension. The actual role of angiography in the evaluation of primitive hepatic diseases is stressed.