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Natal women with anorgasmia possess a smaller clitoral glans and clitoral components farther from the vagina lumen than women with normal orgasmic function. There are no studies evaluating this correlation in operated transgender women. We evaluated whether differences in magnetic resonance imaging (MRI) measurements of neoclitoris volume and distance between the neoclitoris and the neo-vagina were correlated with differences in sexual function. We recruited for a prospective survey study 40 operated male to female patients (oMtF) who had undergone gender affirming surgery (GAS), using two different techniques, the pubic neoclitoris technique (PNT) and the neourethroclitoroplasty according to Petrović (NCP), and postoperative pelvic MRI. Individual pelvic MRIs were reviewed by two blinded investigators, the three axes of the neoclitoris were measured and the volume was calculated using the ellipsoid formula. The distance between the neoclitoris and the neovagina was also measured. Sexual functioning was assessed using the Female Sexual Function Index (FSFI) and the operated Male to Female Sexual Function Index (oMtFSFI). Mean scores differences in FSFI, oMtFSFI were examined; associations with clitoral size, location, sexual functioning and demographical variables were investigated as well. The response rate was 55%, 11 oMtFs were operated with PNT and 11 with NCP. The PNT group presented a neo-clitoris mean volume of 1.04 cc vs 1.31 cc of the other group (p = 0.55). The mean distance between neo-clitoris and neovagina was 4.20 cm in the PNT group and 2.55 in the NCP group (p 0.20). According to pelvic MRI measurements, this study suggests a correlation between neoclitoris location and operated male to female sexual satisfaction.

Background and Purpose-Tricuspid valve (TV) apparatus parameters can vary significantly with demographic and anthropometric factors and could be useful for clinical decision making. Our aim was to (1) establish the reference values for TV apparatus parameters using transthoracic three-dimensional (3D) echocardiography; (2) investigate the influence of age, sex, and body size on TV anatomy. Methods-A total of 180 healthy subjects referred in 2015 to our institution for a screening transthoracic echocardiography were enrolled (mean age 49.7+17.4 years, range 20 to 80 years: 30 subjects per age decade were included in the study, 15 for each gender). A real-time zoom 3D image of the TV and full volume 3D data set were collected from an apical window including TV using Philips iE33 and GE Vivid E9 Ultrasound Machines. After acquisition, the 3D data sets were analysed using 3D Qlab and EchoPAC PC softwares. The volumetric data set was analysed with multiplanar reformatting function to obtain three simultaneous orthogonal 2D slices (sagittal, coronal and axial planes). The following TV parameters were obtained and measured: 1. the 3D diastolic annular diameters (Major and Minor diameters); 2. the 3D diastolic annular area (TDAA); 3. the Tricuspid annular fractional area changes (TAFAC). Results are presented as mean ± SD. Differences between and among groups were tested for significance using the independent samples t-test and ANOVA test for continuous variables. Univariate Pearson correlation was used to assess the relation between these parameters and age, and body size. A p 0.05) and normalized MDD (18.1±2.4 vs 18.4±2.3 mm/m2, p>0.05) did not differ significantly between males and females. TTDAA and TAFAC in overall population were 76.7±17.3 mm2 and 29.6±8.6%. TDAA was significantly different between males and females (82.5±18.3 vs 69.7±13.0 mm2, respectively; p 0.05). After normalization for BSA, TDAA in overall population was 43.3±9.0 mm2/m2. Also normalized TDAA was significantly different between males and females (44.4±9.4 vs 42.0±8.4 mm2/m2, p < 0.05). mDD, MDD, TDAA and TAFAC showed no correlation with age (r = 0.16, p 0.04; r = 0.028, p 0.7; r = 0.17, p 0.27; r = 0.16, p 0.16; respectively). Conclusion- This study can provide normal reference values for TV anatomic parameters that may be useful in the clinical practice, considering the effects of age, sex, and body size.

OBJECTIVE. The purpose of this article is to provide radiologists with an introduction to the imaging appearances of various types of penile prostheses and discuss imaging pitfalls. CONCLUSION. Two major types of penile prostheses currently are in use: malleable penile prostheses and inflatable penile prostheses. Sonography is useful in the assessment of the pelvic reservoir and scrotal pump. MRI helps in the complete evaluation of all the prosthetic components, making it a “one-stop shop” imaging technique.

Magnetic resonance imaging (MRI) of the scrotum represents a useful supplemental imaging technique in the characterization of scrotal masses, particularly recommended in cases of nondiagnostic ultrasonographic findings. An accurate characterization of the benign nature of scrotal masses, including both intratesticular and paratesticular ones may improve patient management and decrease the number of unnecessary radical surgical procedures. Alternative treatment strategies, including follow-up, lesion biopsy, tumor enucleation, or organ sparing surgery may be recommended. The aim of this pictorial review is to present how MRI helps in the characterization of sonographically indeterminate scrotal masses and to emphasize the key MRI features of benign scrotal masses.

We studied 8 patients with spinal cord stimulation (SCS) devices which had been previously implanted to treat neuropathic chronic pain secondary to Failed Back Surgery Syndrome. The aim of our study was to investigate the effects of SCS on posture and gait by means of clinical scales (Short Form Health Survey-36, Visual Analogue Scale for pain, and Hamilton Depression Rating Scale) and instrumented evaluation with 3D Gait Analysis using a stereophotogrammetric system. The latter was performed with the SCS device turned both OFF and ON. We recorded gait and posture using the Davis protocol and also trunk movement during flexion-extension on the sagittal plane, lateral bending on the frontal plane, and rotation on the transversal plane. During and 30 minutes after the stimulation, not only the clinical scales but also spatial-temporal gait parameters and trunk movements improved significantly. Improvement was not shown under stimulation-OFF conditions. Our preliminary data suggest that SCS has the potential to improve posture and gait and to provide a window of pain-free opportunity to optimize rehabilitation interventions.

To describe the imaging findings in a series of patients with mesothelioma of the tunica vaginalis testis.We reviewed clinical data, imaging findings and follow-up information in a series of 10 pathology-proven cases of mesothelioma (all had US; 2 had MR) of the tunica vaginalis.A variety of patterns could be observed, the most common (5/10) being a hydrocele with parietal, solid and hypervascular vegetations; one patient had a septated hydrocele with hypervascular walls; one had multiple, solid nodules surrounded by a small, physiological quantity of fluid; one a cystic lesion with thick walls and vegetations compressing the testis; two had a solid paratesticular mass. MR showed multiple small nodules on the surface of the tunica vaginalis in one case and diffuse thickening and vegetations in the other one; lesions had low signal intensity on T2-w images and were hypervascular after contrast injection.A preoperative diagnosis of mesotheliomas presenting as solid paratesticular masses seems very difficult with imaging. On the contrary, the diagnosis must be considered in patients in whom a hydrocele with parietal vegetations is detected, especially if these show high vascularity.Mesotheliomas of the tunica vaginalis are rare, often challenging to diagnose preoperatively. Most common finding is a complex hydrocele with hypervascular parietal vegetations. Septated hydrocele, nodules without hydrocele, a thick-walled paratesticular cyst are less common. Preoperative diagnosis may allow aggressive surgical approach and, possibly, a better prognosis.

The aim of our study was to analyze changes in spectral Doppler waveforms between interlobar and interlobular arteries in renal transplants and to determine whether sampling location at interlobular level can be suitable for intrarenal resistive index (RI) measurements. Paired series of spectral tracings from interlobar arteries and respective interlobular branches were obtained in 62 consecutive renal transplants at 6.5-MHz Doppler frequency. The values of peak systolic velocity (PSV), end diastolic velocity (EDV) and RI were significantly (P < 0.01) reduced when calculated at interlobular level. In 38 % of cases, an interlobar RI higher than 0.70 corresponded to a normal interlobular RI. The values of PSV, EDV, and RI did not differ significantly at interlobular level between allograft subsets with normal and elevated serum creatinine level. Both intra- and interobserver variation were higher at interlobular than at interlobar level when performing the RI. During a conventional study of renal vasculature, an underestimation of abnormal RI findings can be expected from the incidental evaluation of interlobular tracings. We recommend sonologists to pay attention in accurately locating the sample volume at interlobar–arcuate level when evaluating intrarenal RI.

Nucleosomes, chromatin and nuclei, extracted from rat hepatocytes, were studied by an experimental configuration which measures circular intensity differential scattering (CIDS) and other elements of the polarized light scattering matrix. The Mueller matrix elements, S/sub 14/ and S/sub 34/, that are related to the geometric parameters of the superhelical arrangement of polynucleosomes point to the existence of a quarternary structure at low ionic strength for chromatin prepared by the cold-water method, which is lost by shearing, and is not found in the soluble chromatin prepared through the nuclease method. Only the addition of salt to produce a final concentration of 5 mM MgCl/sub 2/, 150 mM NaCl and 10 mM Tris HCl (pH 7) yields a sizable (S/sub 14/+S/sub 34/) signal in the latter chromatin. This signal is however still different from the corresponding signal of native nuclei and of cold-water chromatin. The (S/sub 14/+S/sub 34/) signal from isolated nucleosomes in consistently very low (nearly zero) as predicted by multiple dipole simulation within the framework of classical electrodynamics. Results are discussed in terms of the topological constraints present in the native long chromatin fiber, which are lost after limited nuclease digestion and after shearing. >

This study was done to assess the enhancement characteristics of splenic implants and to evaluate whether contrast-enhanced ultrasound (CEUS) after SonoVue injection allows the differential diagnosis with peritoneal metastases.Thirteen consecutive patients with splenosis and 13 consecutive patients with peritoneal metastases were investigated with CEUS after injection of 2.4 ml of SonoVue. Lesion enhancement was evaluated in real time for 240 s. All examinations were recorded digitally and analysed retrospectively. Frames were selected at different time intervals ranging from 0 to 4 min after injection. Average signal intensity was evaluated by measuring the average grey level in a region of interest encompassing the entire nodule. Results were evaluated using the Mann-Whitney test and interobserver variability using the Bland and Altmann method.Splenic grafts presented with intense enhancement and without significant washout. Metastases presented with variable enhancement and progressive washout. Signal intensity values were significantly higher for splenic grafts, starting from 40 s after microbubble administration. Starting from 90 s after injection, there was no overlapping between enhancement of splenic grafts and peritoneal metastases, and only splenic grafts showed a percent of enhancement higher than 60% of the maximum enhancement.CEUS after SonoVue injection may be considered a valuable alternative to scintigraphy for characterising peritoneal splenic grafts without radiation.

Continuous enhancements in computer technology and the current widespread computer literacy among the public have resulted in a new generation of students that expect increasingly more from their e-learning experiences. To keep up with such expectations, e-learning systems have gone through a radical change from the initial text-based environments to more stimulating multimedia systems. E-learning functionalities are now also being extended to mobile platforms in order to be more available and convenient for users. Many mobile learning applications have now been developed and they too are becoming more advanced. However, providing truly collaborative and interactive mobile learning tools still remains a challenge. In this paper, we present a desktop e-learning system called CLEV-R and in particular a component of the system that we have developed for mobile devices. This mobile component explores the possibility of providing collaboration tools for mobile learners while also presenting the learning experience through an engaging 3D environment.

To assess urethral vascularization in healthy young women, using colour Doppler ultrasonography.Eleven healthy young women volunteers (mean age 33.6 years, range 24-46) with no pelvic floor disorders and no history of incontinence were assessed. The subjects underwent colour Doppler ultrasonography using a 4-7 MHz convex broadband transducer. Translabial sagittal scans of the urethra were taken when the subjects had a full bladder, both during the oestrogenic and progestogenic phases. The colour Doppler ultrasonography parameters were optimized to detect slow flows in the anterior and posterior distal, middle and proximal urethra. A rank-sum nonparametric test was used to assess differences between the resistive indices.The statistical evaluation showed a significant difference in the resistive index only in the anterior urethra, between the distal and middle plus proximal urethra, in both the progestogenic (P = 0.002) and oestrogenic (P = 0.0127) phases.This study confirmed that the vascularization of the urethra plays an important role in the 'seal' effect, which is considered one of the most important factors in urethral closure. There was a significantly greater resistive index in the anterior proximal urethra than in the middle and distal urethra. These findings suggest that the seal effect is related to the existence of a rich venous urethral vascularization, involved in the mechanism of urethral closure. Colour Doppler ultrasonography of the urethra seems to be feasible and useful for understanding the mechanism of the vascular component in female continence.

Ultrasonography is the first imaging approach in evaluation of patients with urinary obstruction. Presence of hydronephrosis, urinomas and inflammatory complications can be assessed. Moreover, the level and the cause of obstruction are often identified. The major limits of ultrasonography are poor visibility of the lumbar portion of the urinary tract and lack of specificity in detection of pyelocaliectasis. These limits are partially overcome with Doppler studies. Several factors can bias diagnostic accuracy of colour Doppler ultrasonography in evaluating renal obstruction; in particular, partial or intermittent obstruction cause minimum hemodynamic changes in patients with renal colic. Sensitivity of colour Doppler ultrasonography to detect obstruction decreases following medical treatment with NSAID and increases following hydration and diuretics administration. Diuretic ultrasound, colour Doppler evaluation of ureteral jets and evaluation of the twinkling artefact of stones are useful imaging techniques as well. Tissue harmonic imaging is a new imaging technique available in most latest generation US equipments. Evaluation of the kidney and of the urinary tract improves using this technique due to artefact reduction and increased contrast resolution.

Acute Renal Failure (ARF) is characterized by a rapid decline of the glomerular filtration rate, due to hypotension (prerenal ARF), obstruction of the urinary tract (post-renal ARF) or renal parenchymal disease (renal ARF). The differential diagnosis among different causes of ARF is based on anamnesis, clinical symptoms and laboratory data. Usually ultrasound (US) is the only imaging examination performed in these patients, because it is safe and readily available. In patients with ARF gray scale US is usually performed to rule out obstruction since it is highly sensitive to recognize hydronephrosis. Patients with renal ARF have no specific changes in renal morphology. The size of the kidneys is usually normal or increased, with smooth margins. Detection of small kidneys suggests underlying chronic renal pathology and worse prognosis. Echogenicity and parenchymal thickness are usually normal, but in some cases there are hyperechogenic kidneys, increased parenchymal thickness and increased cortico-medullary differentiation. Evaluation of renal vasculature with pulsed Doppler US is useful in the differential diagnosis between prerenal ARF and acute tubular necrosis (ATN), and in the diagnosis of renal obstruction. Latest generation US apparatus allow color Doppler and power Doppler evaluation of renal vasculature up to the interlobular vessels. A significant, but non specific, reduction in renal perfusion is usually appreciable in the patients with ARF. There are renal pathologic conditions presenting with ARF in which color Doppler US provides more specific morphologic and functional information. In particular, color Doppler US often provides direct or indirect signs which can lead to the right diagnosis in old patients with chronic renal insufficiency complicated with ARF, in patients with acute pyelonephritis, hepatic disease, vasculitis, thrombotic microangiopathies, and in patients with acute thrombosis of the renal artery and vein. Contrast enhanced US is another useful diagnostic tool in patients with ARF which has been recently introduced in clinical practice. Microbubble administration may reduce technical failure in the evaluation of the renal artery. Moreover, perfusion defects due to stenosis or thrombosis of the renal segmentary vessels are better recognized. New diagnostic possibilities of enhanced US include evaluation of both cortical and medullar vessels, and functional evaluation of renal perfusion. Measuring the transit time of the microbubbles is useful for the diagnosis of renal artery stenosis and, in transplanted kidneys, for differential diagnosis between ATN and acute rejection.

In many types of cells, ligation of human leukocyte antigens (HLA) Class I molecules with specific mAbs results in the transduction of signals that trigger different cell functions. We have investigated the effects of Class I ligation in human neutrophils. After several hours in culture, neutrophils split spontaneously into two subpopulations, one with normal and the other with reduced levels of Class I. The latter subpopulation displayed high binding capacity for Annexin V, showed a hypodiploid peak, electrophoretic DNA fragmentation, and morphological features of apoptotic cells. The addition of drugs known to delay apoptosis (GM-CSF or cAMP) resulted in a reduction of Class I modulation. Furthermore, ligation of surface Class I with F(ab')2 fragments of the anti-Class I mAb W6/32 resulted in a delay in the progression of apoptosis. These data indicate that this surface Class I molecule is a marker of age-related apoptosis, and the ligation of these molecules results in the transduction of a signal that inhibits apoptosis. Thus, the downregulation of HLA Class I molecules in aging neutrophils prevents their halting the apoptotic process.

All the concepts and principles commonly espoused in plastic surgery are very useful in urologic reconstructive operations too. Hypospadia's repair, neo-bladder reconstruction, microsurgery of the seminal way require as certain rules as an absolute respect for anatomy, sparing of the finest tissue vascularization and tension free sutures. Pedicled skin flaps harvesting and utilisation are techniques typical of plastic surgery but are also largely used in urologic adult and paediatric surgery. They are adopted for urethral, penile and corpora cavernosa reconstruction. Pedicled flaps are utilised for the closure of large skin defect in case of complicated wound or when an urinary fistula is present, especially after radiotherapy. A perfect knowledge of the flap nourishment and of the method of harvesting is crucial if the best results must be obtained. In our work we describe the surgical technique for the utilisation of gracilis muscle and forearm flap. Special care is taken to the anatomical description.

Hyperthyroidism in Graves' disease is caused by the presence of circulating autoantibodies to the THS receptors on the thyroid cells. Thyroid-suppression therapy prevents hormone production directly, without affecting the pathogenetic process. We performed color Doppler US of the thyroid gland and pulsed Doppler analysis of thyroid artery flow in 21 patients with Graves' disease before and during medical treatment. US results were compared with those of a control group of 40 healthy subjects and correlated with the values of thyroid hormones, TSH, and thyroid microsomal and thyroglobulin antibodies. The thyroid gland was hypovascularized in the control group. Pulsed Doppler examination of the thyroid arteries exhibited peak systolic velocity of PSV 20 +/- 4 cm/s, diastolic velocity of 8 +/- 1 cm/s, and resistive index of 0.60 +/- 0.04. The thyroid gland of Graves' disease patients was hypervascularized. Pulsed Doppler examination of the thyroid arteries exhibited peak systolic velocity (PSV = 51 +/- 12 cm/s), end diastolic velocity (VD = 15 +/- 4 cm/s), and resistive index (RI = 0.71 +/- 0.04) significantly higher than in normal subjects (p0.001). Circulating thyroid hormones and flow parameters normalized after 6-8 months of medical therapy (PSV = 20 +/- 6 cm/s, VD = 9 +/- 3 cm/s, RI = 0.58 +/- 0.07). Conversely, the color Doppler patterns normalized only in a patient with normal TSH and antibodies. Sampling of the thyroid arteries proved more repeatable than sampling of parenchymal vessels.

The role of Doppler techniques in the differential diagnosis of benign from malignant solid breast lesions remains to be defined; indeed, it is still debated whether the diagnostic findings of Doppler US add further information to mammographic and B-mode US results. We investigated the diagnostic effectiveness of Doppler techniques in the differential diagnosis of breast nodules, especially in a selected group of patients with questionable diagnosis because of atypical morphological features or benign appearance detected in women over 40 years old. Color Doppler studies were performed on 111 breast nodules with solid features at US; 53 vascularized lesions were also studied with duplex Doppler. All the nodules were submitted to biopsy, which demonstrated 6 nonvascularized lesions to be complicated cysts. There were 105 solid breast nodules (65 benign and 40 malignant). Color Doppler US showed vascular signals in 71% of benign nodules, mainly at the periphery. 12% of benign nodules had Doppler signals of malignancy at color Doppler US; 92% of malignant lesions was vascularized, with irregular intratumoral signals in 37% of them. The peak systolic velocity and the resistive index were higher in malignant tumors (p0.02); peak systolic velocity changed in malignant lesions according to tumor size (p0.01). Color Doppler correctly suspected malignancy in 62% of the nodules with questionable features; conversely, 31% of the nodules with questionable findings and no color Doppler signs of malignancy proved malignant at biopsy. In conclusion, the role of Doppler studies remains currently limited in the differential diagnosis of solid breast lesions.

Large cell calcifying Sertoli cell tumor of the testis is an extremely rare type of sex cord tumor with low malignant potential that occurs in the first and second ecades of life. Twenty-eight cases have been reported in the literature and, to our knowledge, only 2 had an aggressive behaviour. Patient age, tumor size, histological malignant patterns such as pleomorphism and high mitotic rate seem to heavy influence the future neoplasm malignancy. Ultrasonography imaging of the large cell calcifying has described in only 6 cases. We report an experience with a large cell calcifying Seroli cell tumor of the testis and point out the unusual sonographic findings. Moreover, if histologic examination suggests no malignant features, we suggest local excision as ideal therapy for the preservation of testicular parenchyma.

During sonographic examination of the extremities using high frequency "small-parts" equipment, peripheral nerves may be identified in virtually all patients. Peripheral nerves have a typical ultrasonographic pattern that correlates well with histologic structure and facilitates differentiation between nerves and tendons. The ability of this technique to depict peripheral nerves makes it possible, in many instances, to study nerve abnormalities in trauma, entrapment syndromes and tumors. Ultrasound can enable differentiation of an endoneural from an extraneural space-occupying lesion and evaluation of the extent and consistency of the lesion, as well as the integrity and dynamic behavior of the nerve involved at follow-up study. The purpose of this review article is to describe the normal ultrasonographic appearance of peripheral nerves and to discuss the potential role of this technique to image nerve lesions noninvasively. A series of paradigmatic ultrasound images of diverse pathologic processes involving peripheral nerves is presented. Although the ultrasound study of peripheral nerves remains in its infancy, with further refinement of ultrasound technology and a more precise knowledge of the ultrasound appearance of the extremities we may be optimistic to the future impact of this technique on diagnosis, treatment and prognosis in patients clinically suspected to have a nerve lesion.

Three normal volunteers and 20 patients with known Crohn's disease were examined with MRI--at 0.5 Tesla and with a superconductive magnet. Coronal T1-weighted GE images were mainly acquired, before and after i.v. Gd-DTPA injection in breath hold (TR 70 ms, TE 13 ms, FA 70 degrees). MR findings were compared with the results of small and large bowel enema. In 6 patients (30%) the abnormal loops were missed. In the other 14 patients (70%) MRI did depict the affected loops in the same sites as depicted by conventional radiography. The bowel wall was thickened (4-10 mm) in all patients. In 10 patients the thickened wall was markedly enhanced after Gd-DTPA injection. In 6 patients MRI demonstrated disease complications--i.e., stenoses, fistulae and abscesses--missed by conventional radiography. In 7 patients MRI showed the bowel to be more involved than demonstrated by conventional studies. Bowel wall thickening appeared to be a constant and reliable sign of disease. Wall enhancement was a less frequent sign but, when present, it was considered as characteristic as wall thickening. In the staging of Crohn's disease, MRI yields more pieces of information than conventional radiography and depicts the involvement of the intestinal wall and of its surrounding spaces.

Low-dose dopamine is commonly used for the management of acute renal failure because of its exclusively renal vasodilator effect which is mediated through two specific receptors. However, the experimental background of this role is controversial in man. Indeed, the available data come mainly from animal trials and uncontrolled studies in patients with left ventricular dysfunction who need other drugs to improve cardiac output. This work was aimed at investigating Doppler value in assessing the effects of low-dose dopamine infusion in healthy subjects. Heart rate, arterial blood pressure and RI were measured before, during (at 10, 20 and 30 minutes) and after low-dose dopamine infusion in 4 healthy volunteers. In all subjects the RI reduced significantly, returning to the initial values after drug infusion. Indeed, the average RI (0.648 +/- 0.015 before drug administration) decreased to 0.595 +/- 0.026 within 10 min of infusion and remained almost the same during the infusion (0.596 +/- 0.024 within 20 min of infusion, 0.585 +/- 0.032 within 30 min). Within 10 min of the end of infusion, the average RI returned to similar values to those measured before drug administration (0.643 +/- 0.02). Changes in heart rate and arterial blood pressure were not significant. Our results confirm the vasodilator role of low-dose dopamine to be free of systemic effects in healthy volunteers with no therapeutic support which would cause extrarenal decrease in peripheral vascular resistance.