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Despite significant advances in pharmacological and non-pharmacological therapy, epidemiological data from European and US hospitals show that the prevalence of heart failure (HF) hospitalization, especially for patients >65 years, continues to rise. Hospitalization for worsening HF is one of the most important predictors of short- and long-term outcomes in patients with chronic HF. There is therefore a clear need for new therapies that can work synergistically with standard medications to reverse the progression of the disease and improve myocardial efficiency. In the last years, researches in chronic HF focused on drugs that can exert a greater attenuation of neurohormonal activation and that can improve cardiac energy and substrate utilization.

The authors evaluated 97 knees out of a series of 135 fractures of the femur in 130 patients, revealing 34 cases of capsuloligamentous laxity, equal to 35% of the cases. No specific correlation between type of trauma, type and site of fracture, and lesion of the ligaments was observed. The frequency of unrecognized lesions, particularly in the posterior capsule, was made evident. The frequency of ligamentous lesions rises to 44.4% when fracture of the femur is associated with fracture of the homolateral tibia as compared to 26.7% in cases of isolated fracture of the femur. Recurvatum, which was present in a fair number of the cases, was related more to post-fracture therapy and rehabilitation rather than to specific capsuloligamentous lesion of the knee.

From October 1989, in our Radiology Department, digital radiographic techniques have been applied to double-contrast arthrography of the knee. In this preliminary work we examine the diagnostic contribution of computed radiography to arthrographic findings by comparing image quality of conventional and digital radiographs using a dedicated Philips unit. The digital unit is compatible with all the extant radiographic equipment in our department and automatically supplies two images, the first one resembling a conventional radiograph, the second one characterized by a broader exposure range that allows a clear visualization of soft tissues. To obtain high-quality radiographs the processing curves of the system were modified, in particular by shifting the curve leftward, thus reducing its slope, and by amending the parameters related to spatial frequencies. The changes in the reading curves made these images more useful: they were more homogeneous and allowed a better evaluation of fine details. Relative to the second type of images, characterized by both edge enhancement and a broader recording range, it was enough to shift the curve along the X-axis to compensate for a moderate image overexposure. Keeping in mind that the aim of this preliminary work was not compare the two techniques from a diagnostic point of view, in the authors' opinion the two yield similar information for the diagnostic evaluation of meniscal traumas. On the contrary, if the same principles are applied to the evaluation of capsulo-ligamentous components, digital arthrography appears to be more accurate than the conventional technique, the latter being deceptive especially in the evaluation of cruciate ligaments.

Twenty-nine patients with peripheral intrathoracic lesions underwent real-time US and US-guided biopsy. The lesions were mainly atypical fluid collections in 3 patients and mainly solid in the extant 26. Biopsies performed with fine aspirating or cutting needles (20-22 gauge) were successful in all patients; an unquestionable diagnosis was made in 27 cases with cytology and/or histology. Only one patient experienced mild asymptomatic pneumothorax after biopsy, which did not require chest-tube drainage. The authors stress the important diagnostic role of US-guided fine-needle biopsy as an useful and safe method for the evaluation of peripheral intrathoracic lesions.

The authors report their experience with the routinary use of a computerized digital radiography system in Intensive Neonatal Care department. The conventional screen-film system is replaced by photostimulable imaging plates, which are scanned during processing by a laser providing the digital image. The latter is subsequently processable on high-resolution monitors. Over a 6-month period 86 examinations were performed with this method in Intensive Neonatal Care; good technical results were obtained. The use of digital radiography in intensive neonatal care is extremely promising for it allows high-quality images to be obtained, and radiation dose and number of acquisitions to be reduced. Finally, work stations allow both selective visualization of different body structures and their magnification.

The authors reviewed 122 patients affected with popliteal cysts and treated between 1975 and 1985 with or without surgery; follow-up ranged from 1 to 7 years (average 3 years and 2 months). The patients were subdivided into 3 age groups, and observed for the clinical, anatomo-pathological and therapeutic differences among them. Cysts affecting children and adults were considered to be acute, or chronic bursitis, and those affecting elderly patients true cysts deriving from the joint cavity. The diagnostic effectiveness of arthrography and sonography is emphasized.

The authors conducted a statistical study and a critical review on a series of 1,300 patients examined with double-contrast fluoroscopically guided knee arthrography using a simple examination technique. Arthrographic diagnoses were subsequently compared with arthrotomic (500 patients), arthroscopic (350 patients), and clinical (450 patients) diagnoses. The critical review pointed out the high diagnostic accuracy (90%) and the good sensitivity (87%) of arthrographic examination in patients affected with pathologic conditions of the cruciate ligaments. In collateral ligament diseases and in capsular ruptures arthrographic sensitivity was not as high but still acceptable (74%). Capsular tears and medial collateral ligament tears can be identified when contrast medium is seen leaking from the knee joint. Cruciate ligament tears may be partial or complete: if a tear is partial the synovial surface of the cruciate ligament cannot be identified the cruciate ligament is wavy, lumpy, or focally thin, while in complete tears the synovial surface of the cruciate ligament cannot be identified either entirely or partially.

Three cases of posterior apophyseal fracture of a lumbosacral vertebral body are described. This disco-apophyseal lesion is typical of adolescents and sports-related trauma. Like all acute and chronic apophysiolyses it is probably enhanced by a constitutional weakness of the apophyseal area, closely fused with the anulus fibrosus of the disc.

A computed radiographic system for generating and archiving digital radiographic images was employed in ivp. The system produces 2 digital images per exposure: the first one simulates a conventional radiograph, while the second enhances some spatial frequencies and emphasizes the structure borders. The conventional radiographs and the digital images of 50 patients submitted to ivp were reviewed by four experienced radiologists to evaluate their comparative quality, and the results were statistically analyzed. Digital images proved to be better than conventional radiographs for some of the selected parameters, especially in the evaluation of renal edges and sometimes for calyceal opacification. As for the other parameters, no statistically significant difference was observed between conventional radiographs and digital images.

Aging and female sex are major risk factors for cholesterol gallstones: in addition to hepatic secretion of lithogenic bile, decreased gallbladder contractility may play a role in such physiological conditions. This study was aimed at evaluating the effect of age and sex on gallbladder kinetics in healthy subjects. Gallbladder volume was measured on the US images of 157 fasting subjects using the sum-of-cylinders method. No significant difference was observed between males and females. On the contrary, age was shown to have a significant positive correlation with fasting gallbladder volume, particularly in males. In a second group of 63 healthy volunteers gallbladder volumes were evaluated both before and after a standard meal. The subjects were grouped according to age, and fasting gallbladder volume appeared to be significantly greater in the groups formed by older people. Gallbladder volumes were compared in younger groups (under 35), and gallbladder emptying resulted to be much more complete in males than in females. On the contrary, no significant difference was observed between males and females over 50--which suggests a possible role of sex- and age-related hormonal factors. The above changes in gallbladder function may facilitate bile stasis which might in turn contribute to the increased risk for cholesterol gallstones notoriously associated with advanced age and female sex.

The authors performed a statistical study on a series of 1000 patients examined with double-contrast fluoroscopically-guided knee arthrography. Arthrographic diagnoses were compared with the arthrotomic (500 patients), arthroscopic (350 patients) or clinical diagnoses of 150 patients with a follow-up of 6 months. In this series of patients with a history of "recurrent meniscal injury", arthrographic diagnoses were confirmed in a high percentage of cases, with 96.9% accuracy, 96.7% sensitivity for tears, and 98.6% specificity. On the basis of these results the authors suggest double-contrast arthrography as an examination of considerable value in the diagnosis of meniscal lesions, while in their opinion arthroscopy should be limited to questionable cases, to complex lesions with involvement of multiple articular structure and to the alterations clearly treatable by arthroscopy.

Personal experience of the intra-operative use of oesophageal manometry in cases of hiatus hernia is presented. Using this system the pressure in the air cushion surrounding the L.E.S. can be adjusted to avoid any complications due to overtight or overlax surgery. Various types of post-operative tests confirm the value of the technique.

The authors report a case of shunt-nephritis due to bacteremia from Stafilococcus albus. Kidney biopsy, comprehensive of IF study allowed to assess the diagnosis of a disease from immunocomplexes. The Authors stress the importance of a close follow-up of patients who carry liquoral shunt for an early recognition of symptoms of glomerulopathy.

The authors face the problem of accuracy, specificity and sensitivity of double-contrast arthrography in meniscal injury of the knee. They report the results obtained in a clinical-statistic and retrospective investigation on 206 patients. The final diagnoses were obtained by arthrotomy (105 cases) by arthroscopy (70 cases) and clinically with a follow-up of 6 months (31 patients). Diagnostic accuracy (94,5%), sensibility (92%), specificity (98,7%) and predictive values on positives (99%) and negatives (87,5%), confirm double-contrast arthrography as a highly accurate examination. A specific diagnosis can be made only when the diagnostic modalities are correctly applied and the arthrographers are qualified.