Combined effect of atmospheric gas plasma and UVA light: A sustainable and green alternative for chemical decontamination and microbial inactivation of fish processing water

The simultaneous use of UVA light irradiation coupled with low energy cold plasma generated by a dielectric barrier discharge prototype, results in significant enhancement of efficiency of the integrated process with respect to the sole plasma treatment. This effect has been demonstrated both on microbial inactivation of a food-borne pathogen, i.e. Listeria monocytogenes, and on the degradation of a compound of biological origin such as phenylalanine. In the latter case, the analysis of its reaction intermediates and the spectroscopic identification and quantification of peroxynitrites, allowed to propose mechanistic hypotheses on the nature of the observed synergistic effects. Moreover, it has been demonstrated that the process does not affect the quality of trout fillets, indicating its suitability as a chlorine-free, green, and sustainable tool for the decontamination of fish processing water.

Influence of non-phosphate and low-sodium salt marination in combination with tumbling process on properties of chicken breast meat affected by white striping abnormality

This study investigated the effects of non-phosphate and low-sodium (NPLS) marination on properties of white striping chicken breasts (WSCB). Chicken breasts were collected from slaughterhouse and classified as normal (NCB, n = 24) and severe WS (WSCB, n = 120). Sixty WSCB samples were vacuum-tumbled (30 min, 2 °C) with NPLS solution, containing 2.8% (w/v) potassium bicarbonate, 2.9% (w/v) potassium chloride, and 1.5% (w/v) sorbitol at the ratio of meat-to-marinade of 4 to 1 (w/w). The other 60 WSCB received no marination were assigned as nonmarinated WSCB. Properties of marinated (n = 12) and nonmarinated (n = 12) WSCB samples were determined at 0, 3, 7, 10, and 14 days of the storage at 4 °C. Properties of the NCB were also determined on day 0. Concerning day 0, the marinated WSCB exhibited higher (p < 0.05) pH, moisture content, total cooked yield, protein solubility, hardness, cohesiveness, and chewiness along with lower (p < 0.05) cooked loss, expressible water, and shear force than those of nonmarinated WSCB and NCB. Based on nuclear magnetic resonance spectroscopy, bound, intra-myofibrillar, and extra-myofibrillar water of cooked marinated WSCB were greater (p < 0.05) than those of cooked nonmarinated WSCB. The greater (p < 0.05) weight loss, moisture content, and total cooking yield were observed in marinated samples compared to those of nonmarinated WSCB throughout the storage period. Although microbial stability was reduced (p < 0.05), no difference (p ≥ 0.05) in lipid oxidation was detected between the treatments. The findings suggest the NPLS marination as a promising process for improving water holding capacity of the WSCB. PRACTICAL APPLICATION: This study presents the promising application of non-phosphate, low-sodium (NPLS) marination combined with vacuum-tumbling in improving water holding capacity of chicken breast meat affected with white striping condition. Although microbial stability of the marinated breast was negatively affected, no adverse impacts on lipid oxidation was observed during storage up to 14 days.

Fermented Nut-Based Vegan Food: Characterization of a Home made Product and Scale-Up to an Industrial Pilot-Scale Production

Because of the impossibility to consume food of animal origin, vegan consumers are looking for substitutes that could enrich their diet. Among many substitutes, fermented nut products are made from different nut types and obtained after soaking, grinding, and fermentation. Although other fermented vegetable products have been deeply investigated, there are few data about the fermentative processes of nut-based products and the microbial consortia able to colonize these products are not yet studied. This study characterized a hand-made vegan product obtained from cashew nut. Lactic acid bacteria responsible for fermentation were identified, revealing a succession of hetero- and homo-fermentative species during process. Successively, some lactic acid bacteria isolates from the home-made vegan product were used for a pilot-scale fermentation. The products obtained were characterized and showed features similar to the home-made one, although the microbiological hazards have been prevented through proper and rapid acidification, enhancing their safety features.

PRACTICAL APPLICATION

Spontaneous fermented products are valuable sources of microorganisms that can be used in many food processes as starter cultures. The lactic acid bacteria isolated in this research can be exploited by industries to develop new foods and therefore to enter new markets. The use of selected starter cultures guarantees good organoleptic characteristics and food safety (no growth of pathogens).

The same microbiota and a potentially discriminant metabolome in the saliva of omnivore, ovo-lacto-vegetarian and Vegan individuals

The salivary microbiota has been linked to both oral and non-oral diseases. Scant knowledge is available on the effect of environmental factors such as long-term dietary choices on the salivary microbiota and metabolome. This study analyzed the microbial diversity and metabolomic profiles of the saliva of 161 healthy individuals who followed an omnivore or ovo-lacto-vegetarian or vegan diet. A large core microbiota was identified, including 12 bacterial genera, found in >98% of the individuals. The subjects could be stratified into three “salivary types” that differed on the basis of the relative abundance of the core genera Prevotella, Streptococcus/Gemella and Fusobacterium/Neisseria. Statistical analysis indicated no effect of dietary habit on the salivary microbiota. Phylogenetic beta-diversity analysis consistently showed no differences between omnivore, ovo-lacto-vegetarian and vegan individuals. Metabolomic profiling of saliva using ¹H-NMR and GC-MS/SPME identified diet-related biomarkers that enabled a significant discrimination between the 3 groups of individuals on the basis of their diet. Formate, urea, uridine and 5-methyl-3-hexanone could discriminate samples from omnivores, whereas 1-propanol, hexanoic acid and proline were characteristic of non-omnivore diets. Although the salivary metabolome can be discriminating for diet, the microbiota has a remarkable inter-individual stability and did not vary with dietary habits. Microbial homeostasis might be perturbed with sub-standard oral hygiene or other environmental factors, but there is no current indication that a choice of an omnivore, ovo-lacto-vegetarian or vegan diet can lead to a specific composition of the oral microbiota with consequences on the oral homeostasis.

Microbiota and metabolome associated with immunoglobulin A nephropathy (IgAN)

This study aimed at investigating the fecal microbiota, and the fecal and urinary metabolome of non progressor (NP) and progressor (P) patients with immunoglobulin A nephropathy (IgAN). Three groups of volunteers were included in the study: (i) sixteen IgAN NP patients; (ii) sixteen IgAN P patients; and (iii) sixteen healthy control (HC) subjects, without known diseases. Selective media were used to determine the main cultivable bacterial groups. Bacterial tag-encoded FLX-titanium amplicon pyrosequencing of the 16S rDNA and 16S rRNA was carried out to determine total and metabolically active bacteria, respectively. Biochrom 30 series amino acid analyzer and gas-chromatography mass spectrometry/solid-phase microextraction (GC-MS/SPME) analyses were mainly carried out for metabolomic analyses. As estimated by rarefaction, Chao and Shannon diversity index, the lowest microbial diversity was found in P patients. Firmicutes increased in the fecal samples of NP and, especially, P patients due to the higher percentages of some genera/species of Ruminococcaceae, Lachnospiraceae, Eubacteriaceae and Streptococcaeae. With a few exceptions, species of Clostridium, Enterococcus and Lactobacillus genera were found at the highest levels in HC. Bacteroidaceae, Porphyromonadaceae, Prevotellaceae and Rikenellaceae families differed among NP, P and HC subjects. Sutterellaceae and Enterobacteriaceae species were almost the highest in the fecal samples of NP and/or P patients. Compared to HC subjects, Bifidobacterium species decreased in the fecal samples of NP and P. As shown by multivariate statistical analyses, the levels of metabolites (free amino acids and organic volatile compounds) from fecal and urinary samples markedly differentiated NP and, especially, P patients.

Phase transition in poly(vinylidene fluoride) investigated with micro-Raman spectroscopy

The phase transition from the non-polar alpha-phase to the polar beta-phase of poly(vinylidene fluoride) (PVDF) has been investigated using micro-Raman spectroscopy, which is advantageous because it is a nondestructive technique. Films of alpha-PVDF were subjected to stretching under controlled rates at 80 degrees C, while the transition to beta-PVDF was monitored by the decrease in the Raman band at 794 cm(-1) characteristic of the alpha-phase, along with the concomitant increase in the 839 cm(-1) band characteristic of the beta-phase. The alpha-->beta transition in our PVDF samples could be achieved even for the sample stretched to twice (2x-stretched) the initial length and it did not depend on the stretching rate in the range between 2.0 and 7.0 mm/min. These conclusions were corroborated by differential scanning calorimetry (DSC) and X-ray diffraction experiments for PVDF samples processed under the same conditions as in the Raman scattering measurements. Poling with negative corona discharge was found to affect the alpha-PVDF morphology, improving the Raman bands related to this crystalline phase. This effect is minimized for films stretched to higher ratios. Significantly, corona-induced effects could not be observed with the other experimental techniques, i.e., X-ray diffraction and infrared spectroscopy.

[The current state of the diagnostics of breast diseases in Lombardy]

PURPOSE

The SIRM study group for senology in Lombardy set the following goals: to quantify the number of radiologist working in public radiology centers and in private credited hospitals in Lombardy; to quantify the number of radiologists working in diagnostic senology and the mean time they devote to this field; to survey the diagnostic equipment used for senology purposes and check its adequacy.

MATERIAL AND METHODS

We considered 58 centers of senology diagnostic imaging in the radiology departments of general hospitals in 8 Lombardy provinces. First we evaluated the screening programs for early breast cancer detection carried out with clinical mammography. All data were evaluated with reference to female residents aged 40 to 69, to the average adherence rates reported in the literature, to the protocols adopted in different centers relative to the examination frequency. Mammography was always associated with a physical examination and then the patient was submitted to radiological investigations to make the final diagnosis. The form we used for data report is summarized in Table I.

RESULTS

In the centers for diagnostic senology we surveyed in 1998, in all 182,724 mammograms, 58,686 breast US examinations and 7,097 needle biopsies for cytology or microhistology were performed; 35.5% of the female population which should have been screened actually underwent the examination and 32.6% of them was also submitted to breast US, while 3.88% underwent FNAB. Sixty-three mammographic units and 62 US units were operated by 152 radiologists. An average 2,900 radiographic investigations per mammographic unit were performed yearly. Each radiologist reported an average 1,202 mammograms a year. Refer to the tables for detailed data reporting by province. Thirty-six per cent of radiologists presently reads more than 1,500 breast examinations a year. The radiologists working in diagnostic imaging in senology devote an average 20% of their working time to this field. As for the technical adequacy of mammographic and US equipment relative to some reference levels reported in detail in the paper, only 42% of the former and 48% of the latter were up to standards.

DISCUSSION AND CONCLUSIONS

Despite the massive work done in the field of senology, the estimated needs of the female population have not been met yet, given the increased demand for senologic examinations and women's growing awareness of the need of early breast cancer diagnosis. The answer to this problem lies in a political health care policy that should promote the current clinical programs increasing both instrumental and human resources. Alternatively screening programs could be planned on a regional basis, with the pro of reaching a larger female population and that of a more homogeneous methodological approach. Our data indicate that breast cancer detection is best achieved with clinical and screening tools: the former can be easily promoted in a short time and could thus make our first goal, while the latter, which is more complex, could be implemented later. Thus, a growing clinical activity could make a very good basis for high quality breast screening programs. Finally, it is necessary to guarantee high quality standards for equipment, methods and training of medical and nonmedical staff.

[Imaging quality of a digital Konica Regius 336 system for thoracic radiology]

INTRODUCTION

Digital radiographic systems permit to optimize execution, depiction and storage of radiological images. Since a Regius 336 digital system (Konica Corp., Tokyo, Japan) devoted to chest radiography was recently installed in the Radiology Department of S. Anna Hospital in Como, Italy, we investigated its performance relative to image quality.

MATERIAL AND METHODS

Konica Regius 336 is a computed radiography system made of a phosphorescence detector plate which is scanned with an infrared semiconductor laser beam. The radiographic image obtained from the detector is subjected to image processing, which allows a stable output and the nonlinear curve typical of conventional radiographic systems. Image quality was assessed based on the following parameters: dose, contrast, noise, and spatial resolution. As reference, we assessed the same parameters on a Cronex 88 analogic chest-changer (DuPont Pharma, North Billerica, Mass, USA).

RESULTS

The Regius 336 air kerma values were always higher than the analogic ones (about 10%), both with and without a chest phantom; noise was also greater than in analogic images, sometimes even doubled. The optical densities of a step wedge and the spatial resolution of the digital chest-changer are independent of the X-ray tube voltage consequent to broader optical latitude. Inversely, the analogic images of the wedges show great optical density variability as a function of the X-ray tube voltage (in a range of 2). The modulation transfer functions of the two systems have the same trend.

DISCUSSION AND CONCLUSIONS

The performance of the Konica Regius 336 is nearly equivalent to that of an analogic system. The main advantages of the digital system are a standard output, lower consumption of radiographic films, higher productiveness and better image quality standard level.

[Photography methods in general and esthetic surgery: clinical significance and impact on surgical performance]

The authors outline and emphasize the use of Polaroid technique in the surgical practice, either in emergency room (pre-, intra- and postoperative photography) or in plastic-reconstructive surgery, where informed consent is needed on the basis of surgical plan. Polaroid photos are suitable to be enclosed in the patient record as well as in the legal documentation. The Polaroid Macro-5SLR camera is specifically useful in the medical practice to improve the doctor-patient relationship.

[An experimental study of the use of synthetic meshes in large abdominal eventrations]

BACKGROUND

The aim of this study is to evaluate the biocompatibility of Angimesh mesh (polypropilene) in rats, usually used to replace or to strengthen the abdominal fasciae.

METHODS

We made an abdominal longitudinal incision of skin and muscles in 20 rats was carried out and two muscular semilunae removed. The incision was occluded with Angimesh mesh fixed by ethilcyanoacrilate glue (first group of rats) or with suture stitches (second group of rats). The animals were sacrificed after 80 days and the stability of the mesh and the presence of endoperitoneal adhesion were evaluated macroscopically, and microscopically the fibrogenesis and inflammation answer.

RESULTS

Two rats of the first group and seven of the second group died before 30 days. The mesh was more steady when fixed by suture. Adhesion in the contact sites between the mesh and the peritoneum was found. Histology did not show any inflammation reaction but showed a fibrogenic answer.

CONCLUSIONS

The cyanoacrilate non-toxicity has been confirmed also in this application. Angimesh mesh showed good biocompatibility and resulted ideal for the synthesis of large abdominal resections.

[The prevention of adhesions in surgery. A clinical review and experimental contribution]

BACKGROUND

The well-known soft tissue healing properties in some rat models as well as the modulating fibroblasts activity of heterologous collagen led us to the hypothesis that it is possible to prevent the peritoneal adhesions in the rat by interposition of the collagen after peritoneal surgery.

METHODS

In this study, the use of Type I heterologous collagen in different physical forms (1% gel, lyophilized sponge, dehydrated film) for the postoperative peritoneal adhesions prevention has been evaluated. In the second part of the experiment; the 1% gel heterologous collagen including the recombinant tissue plasminogen activator (rtPA) has been applied.

RESULTS

The results of both the experiments don't show any improvement in the number and the quality of the adhesions.

CONCLUSIONS

It is cannot be excluded that, increasing the rtPA concentration it is possible to obtain better results, but the great cost and its potential systemic toxicity are limiting factors for its widespread use in order to prevent peritoneal adhesions.

[Mullerian duct cysts. Description of two cases with a minimally invasive therapeutic approach]

Among cystic lesions of the male pelvis, the müllerian duct cyst represents the most commonly recognized abnormality. These lesions are midline in location and should not be confused with the big or cystic utricle because of its different embryologic development. The cysts are usually small and asymptomatic. Two cases of big and symptomatic müllerian cysts treated by minimal invasive approach consisting of aspiration and endoscopic marsupalization are presented.

[The interstitial photocoagulation with laser light of liver tumors]

INTRODUCTION

Interstitial laser photocoagulation (ILP) is a recent interventional procedure performed under US or CT guidance which is capable of inducing thermal necrosis in solid tumors. We have used this technique for about 2 years to treat primary and secondary liver cancers.

MATERIALS AND METHODS

Thirty-five patients, 20 of them with liver metastases and 15 with HCC, have been examined: 59 lesions in all, ranging in diameter 10 to 65 mm. Forty-nine lesions have been followed-up for at least 2 months and 25 for at least 6 months. The treatment was performed positioning one to six (18-21 G) modified Chiba needles in the lesions to be treated, according to their sizes, under US or CT guidance. The optical fibers (400-800 mu) were then inserted and the Laser was fired to administer 1,000 Joule/session, with 5-10 W power range. The US and CT patterns of the ILP-treated lesions are reported.

RESULTS

Dynamic CT examinations 2 months after treatment showed complete tumor destruction in 77.5% of the lesions. The best results were obtained in the lesions < 3 cm phi; in particular, 32/38 lesions (84.2%) < 3 cm and with at least 2 months' follow-up exhibited complete necrosis, as did 6 of 11 lesions (54.6%) over 3 cm phi. When residual tumor tissue was demonstrated, further ILP sessions were useless. We observed only few complications which resolved spontaneously in all cases.

CONCLUSIONS

At present, ILP remains an experimental procedure: further studies on larger series of patients and comparison with the results of other interventional procedures are needed to confirm its efficacy in treating primary and secondary liver cancers.

[Lipoemulsification versus lipoaspiration. Comparison of intraoperative blood loss and surgery time]

Blood loss due to liposuction is one of the main problems in this kind of surgery, blood volume being up to 30%-35% of the whole liposucked volume. We studied the possible lower impact of ultrasound lipolysis in order to obviate this non negligible problem. For this purpose we treated 10 patients, females, aged between 28 and 55, such obese to overweight between 50% and 200%. These patients underwent ultrasound lipolysis surgery after any dietetic or any other treatment against obesity. No patient dropped out of the study. Each patient was treated, under general anesthesia, in a region included between an imaginary horizontal line passing through the umbilicus and another one through the middle of the femur. Thirty minutes after a bilateral infiltration with an epinephrine solution (1:500000 diluted, 28 C) 2 1 volume each side, the right side was treated with the liposucking cannula (0.4 cm diameter), the left one underwent ultrasound lipolysis with a titanium probe (0.5 cm diameter, SMEI Casale Monferrato, Italy). A liposucking probe every 10 minutes into the left side was inserted. Haemoglobin was detected (according to the method of Goodpasture) in the liposucked material. The result showed a statistically significant difference between the blood rate in the lipoaspirate and that one in the ultrasound lysed material. Ultrasound lipolysis is slower than lipoaspiration, but it also shows less risk of hemorrhage and fat embolism.

[Lipoemulsification. A histological study on the action of ultrasound, access site and adipose tissue]

A new mini-invasive technique for the lysis of subcutaneous adipose tissue has emerged in recent years. This directly applies ultrasounds to the tissue by titanium probes. Ultrasounds act on parenchyma tissues, saving the structure and integrity of the blood vessels. Our study show histological features of the subcutaneous adipose tissue evolution just ultrasound-treated up to 30 days after surgery. Five obese female patients underwent the treatment by anesthesia. Before surgery the sites to treat were topically injected with sterile, hypotonic, apyrogen saline solution added with adrenaline, Biopsies have been taken intraoperatively from the border cutis of the holes made for the introduction of the titanium probes and from the subcutaneous adipose tissue. Biopsies have also been taken during a follow-up at 2, 5, 15 and 30 days postoperatively. Drains were positioned in the treated sites for at least 72 hours. The same sites were sutured so at to make later follow-up biopsies easier. Histological specimens were considered according to three dying methods: eosin-haematoxylin, Gomori and acetic orcein. We observed, as a confirmation the safety of the adipose tissue blood vessels, and the substitution of the destroyed adipose tissue with a microfibrillar connective tissue not subject to a sclerogenic evolution.

Vitamin E added silicone gel sheets for treatment of hypertrophic scars and keloids

BACKGROUND

Trauma of various origins can induce a connective tissue disorder that leads to keloids. This condition has yet not been clearly distinguished from scars and hypertrophic scars. Only electronmicroscopic and biochemical data can help to do this. Among some more or less therapeutic approaches, the use of silicon (polydimethylsiloxane) plates, wrapped on the keloid surface, has been reported effective by some authors. These authors also demonstrated that it is not the mechanical pressure that is the mechanism of action, but a direct action on fibroblasts and a hyperhydration of subcutaneous tissue. The authors of this study conceived that the silicon plate may be able to improve the transdermal penetration of a compound such as vitamin E. This vitamin is capable of preserving some important morphologic and functional features of biological membranes by means of its phytilside chain of the molecule acting as a stabilizer of lysosomal membranes.

MATERIALS AND METHODS

Eighty patients of both sexes, aged between 18 and 63 years, who had hypertrophic scars and keloids, were admitted to the trial. The patients were randomized to two groups in a simple-blinded study. Group A: Forty patients whose scars have been covered with silicon plates with added vitamin E. Group B: Forty patients treated with simple silicone gel sheets. No pressure bandages were used, only tape fixing the sheet for 10 hours overnight. The trial lasted for 2 months. The results were recorded at 4 and 8 weeks, evaluating the improvement according to a Scott-Husskinson scale. For objective assessment photos were taken. The results were analyzed by the chi-square test.

RESULTS

At the end of the first month, group A had improved by more than 50% in 85% of cases, whereas the improvement in group B was 55% (P < 0.01). At the end of the second month, 95% of patients in group A had improved by 50%, whereas 75% had improved by 50% in group B (P < 0.05).

CONCLUSIONS

Vitamin E added to the silicon plate scored better than the simple silicon plate at the end of both periods. We have reported the successful combined action of vitamin E and silicone gel sheets in scar treatment, especially in the short-term prophylaxis of hypertrophic scars or keloids.

[Ultrasonic suction lipectomy. A mini-invasive treatment of obesity]

The safety of ultrasounds lipolysis in the treatment of local obesity and lipodystrophies versus suction lipectomy (less blood loss because of a lower impact on blood vessels network, and less mortality) induced us to combine these mini-invasive techniques in the treatment of obese patients. Between 1991 and 1994 we treated 205 patients (146 females, 59 males, 18-59 range age), affected by 1st degree obesity (44.4%), 2nd degree obesity (27.3%) and 3rd degree obesity (28.3%), accordingly to the following schedule: 1) general anesthesia; 2) subdermal infiltration of the operating sites of a cold sodium chloride (0.9%) epinephrine solution (1:10(5), 8 degrees C); 3) 0.5 cm cutaneous incisions; 4) introduction of titanium tips as ultrasounds source; 5) insertion of suction lipectomy probes to remove the adipose tissue destroyed by ultrasounds; 6) drainage of the wide subcutaneous space; 7) setting of elastic bandages. Mortality was zero and very low side effects have been observed. We report an improvement of blood glucose and triglycerides level and blood pressure 30 days after surgery. Fair late postoperative improvement of the blood glucose tolerance test have been seen in 3 cases.

[Cetyltrimethylammonium naproxenate as vaginal lavage in the therapy of vulvovaginal dystrophies in the postmenopause]

A peculiar aspect of the postmenopausal period is atrophy of the lower genital tract, vagina and vulva. This is due to estrogen deficiency and is accompanied by vaginal pH elevation, lower number of lactobacilli and increased incidence of aspecific vulvovaginitis. We tested a new vaginal douche with an antibacterial-anti-inflammatory (non antibiotic-nonsteroidal) principle, cetyltrimethylammonium naproxenate 0.223% as an adjunct to classical estrogen topical replacement therapy. We treated 34 menopausal patients (mean age 67 yrs) in a double parallel controlled (15 A only estrogen topical therapy vs 19 B topical estrogen plus cetyltrimethylammonium naproxenate douches uid) study for 30 days. A significant reduction of symptoms was obtained in both groups although a faster reduction has been seen in the group treated with both drugs (= B). In conclusion a better replacement of physiological pH with reappearance of lactobacilli, a selective action on vaginal pathogens, a faster symptom remission and an higher psychophysical welfare can be attributed to the vaginal douche used in adjunct to classical estrogen topical therapy.

[Pilonidal cysts: the state of the art and the authors' personal experiences]

After a historical review of the pathogenesis and several therapies suggested for the treatment of pilonidal cysts the authors report the results of a retrospective study performed in the Department of Surgery during a period of four years, with at least 12 months follow-up. This study involved 53 patients (35 males and 15 females, 23 years average age) affected by pilonidal cyst. These patients were treated for a month with antibiotic therapy and underwent surgery by general anaesthesia. Before surgery blue methylene was injected in the cyst. Between 4 months and 2 years 5.7% of operated patients relapsed. After 10 days antibiotic therapy they underwent surgery again by local anaesthesia and then they followed an open treatment protocol including collagen and silver sulfadiazine, healing by delayed wound closure. Furthermore a depilating cream for the border of the wound was suggested to the patient. These patients healed in a period between 4 weeks and 2 months. No relapses were observed after at least 12 months. In our opinion there is the rationale to suggest an open treatment of relapsed pilonidal cyst based on the use of heterologous lyophilized collagen and silver sulfadiazine: it is well accepted by the patient and effective in relapses.

[The diagnostic contribution of direct radiographic enlargement and of echography in the study of breast neoplasms]

To compare the diagnostic value and the role of plain radiographic magnification and of ultrasonography (US) in breast cancer evaluation, 83 malignant tumors were studied with mammography, plain radiographic magnification and US. Microcalcifications were not included in our study. All tumors subsequently underwent histology or cytology. In our series, the malignant nature of the lesion was unquestionably proved in 53% of cases while a possible malignancy was suspected in 36% and a benign nature was incorrectly suspected in 11% of cases with mammography. The diagnostic value of plain radiographic magnification was compared with that of US; breast patterns, mammographic and clinical findings were considered. As for breast patterns, plain radiographic magnification was more accurate in evaluating fatty breast than both mammography and US, allowing the correct diagnosis of 58% of questionable mammographic findings, vs. 33% of US. On the contrary, US was more accurate in dense breasts, allowing the correct diagnosis of 77.7% of mammographic misdiagnoses vs. 33.3% only of plain radiographic magnification. As far as mammography is concerned, US was more accurate than plain radiographic magnification in the assessment of round masses (71.4% vs. 38.1%, respectively), whereas plain radiographic magnification was more accurate than US in stellate masses (100% vs. 92.7%, respectively). As far as clinical findings are concerned, plain radiographic magnification sensitivity was substantially the same in the assessment of symptomatic and asymptomatic lesions (91.5% vs. 89%, respectively), whereas US sensitivity was higher in symptomatic (97%) than in asymptomatic (69%) lesions. The rate of false-negative US diagnoses (14.4%) was higher than those of mammography and of plain radiographic magnification. Negative US findings must be considered with caution and are not sufficient to settle a radiologic doubt.

[Ultrasonic liquid medium for lipo-emulsification. An experimental study]

The technique of ultrasonic lipo-emulsification is currently gaining increasing support. This method consists in the dissolution of human adipose tissue using ultrasound generated by a special appliance and transmitted using (mini-invasive) titanium probes inserted into the subcutis. This procedure is preceded by the infiltration of subcutaneous fat using specially studied hypotonic solutions. On the basis of their previous experience and using data reported in the literature, the authors carried out a study to establish whether among the solutions routinely used there are alternative saline solutions which might enhance the lipolytic efficiency of ultrasound or allow possible saving in terms of time and money. Samples of ex-vivo subcutaneous adipose tissue weighing 5 g were exposed to ultrasonic energy at a frequency of 19800 Hz and an output of 65 Watt until fully dissolved. Prior to this the samples were immersed in a saline solution commonly used in clinical practice for perfusion at a different osmotic pressure. The authors succeeded in identifying saline solutions able to mediate the lipolytic ultrasonic action with greater efficiency than the solutions currently used by other authors.

[Ultrasonic lipoemulsification: a working definition and ex-vivo study on human adipose tissue]

On the basis of previous reports by other authors which have become increasingly numerous over the past years, we have focused our attention on the use of ultrasonic energy in the medical field to resolve medical and cosmetic problems, such as lipodystrophy and diffuse subcutaneous adiposity. In order to standardise the dissolution times of human subcutaneous adipose tissue we used a ultrasonic generator operating at a constant frequency of 19800 Hz, but which was able to emit a range of power from 0 to 100 Watt. The ultrasounds were applied (according to a scale of power) using a titanium probe to fat samples with a volume of 1 cm until each sample had fully dissolved. This allowed the levels of greatest working efficiency to be established for the most commonly used probes.

[An experimental study of a new ultrasonic scalpel. Observations on the quality of the ultrasonic effect and the prospects for its clinical use on different parenchyma and tissues]

The ultrasonic scalpel has been used for some time in surgery in tissue with a predominantly cellular component since it can be used selectively on the parenchymatous component while respecting the vasculo-stromal component. On the basis of their earlier experience and using a versatile ultrasonic device currently utilised in plastic surgery, the authors subjected a series of animal organs to ultrasonic action at a frequency of 19800 Hz and with an output of 65 Watt. The aim of the study was to evaluate the widest potential in terms of efficiency and safety for the use of a ultrasonic scalpel on a vast range of animal parenchyma (batches of Sprague-Dawley rats). The authors' comments and histological results highlight the striking efficiency of this form of energy in the dissolution of parenchyma while respecting the organ's vascular and stromal components.

[Computed tomography features after cystectomy]

Continent urinary diversions are most often performed in the patients who underwent cystectomy for malignancy, typically an invasive bladder carcinoma. There is no ideal surgical technique suitable to every case to reconstruct the lower urinary tract because many factors affect patients selection--e.g., tumor stage, patient's age and overall condition, and so on. Since radiologists play an important role in following up these patients, they must be familiar with postoperative anatomy to detect complications promptly. From 1985 to 1991, forty-two patients underwent radical cystectomy and urinary diversion; four different kinds of diversion were performed: ureterocutaneostomy, ureteroileocutaneostomy, ureterosigmoidostomy and total bladder replacement with ileal or ileocecal segments. The patients were examined with CT six months after surgery and then every year. The usual postoperative CT findings are reported. In the patients who underwent radical cystectomy, a loop of sigmoid colon fills the space left empty by surgery; less frequently, a loop of ileum or of both ileum and sigmoid colon occupies the bladder fossa. The CT findings in the four different kinds of diversion were different enough to be easily distinguished: ureters joined to skin, to an ileal loop or to sigmoid colon are found in ureterocutaneostomy, ureteroileocutaneostomy and ureterosigmoidostomy, respectively. Also the two examined kinds of neobladder (Lebag and "Padovana" techniques) exhibited different volumes and shapes. The anastomosis between ureters and intestinal segment could not be identified in all cases. Nonetheless, CT is the imaging method of choice after cystectomy, as it allows the thorough evaluation of the genitourinary apparatus.

[A protocol for evaluating screen-film systems]

When a competition is made for the supply of sensitive photographic material, each USL is asked, in a time scan of one or more years, to evaluate the characteristics of the screen-film systems proposed by the various companies. In the last years the authors had several opportunities to check different screen-film systems for many Friuli-Venezia Giulia hospitals. For this reason they have set an evaluation form tested after following changes and recently employed in its final version. The check form is reported on in this paper with some personal considerations originated by the authors' experience. The technical parameters which must be evaluated are reported, together with the instrumentation needed to perform the technical examination, the examination modality, and the score-attributing criteria. The evaluation form is very flexible for it allows each Radiology Department to evaluate each parameter in a personal way and to fit it to its own needs.

[The imaging diagnosis of hepatic focal nodular hyperplasia]

Focal nodular hyperplasia (FNH) is a rare benign hepatocellular tumor occurring in noncirrhotic patients, mostly females, 20-50 years of age. It is usually asymptomatic. The authors took the lead from 5 cases of FNH studied over last year to analyze the different patterns exhibited by the condition on the various imaging techniques currently available. At scintigraphy with 99mTc DISIDA or with TcSC, FNH can be hyper, normal, or hypocaptating. On US scans, the lesion is often homogeneous and isoechoic, but it can also be hyper/hypoechoic. With Doppler US, high-flow signals can be observed. On unenhanced CT scans the lesion is solid, well-demarcated, isodense or slightly hyperdense; sometimes it shows a central hypodense area corresponding to fibrovascular scar. On postcontrast scans it appears hyper/isodense. At dynamic CT the lesion density, which is high during the arterial phase, decreases quickly in the parenchymal and the venous phases and reaches equal/inferior values to surrounding liver parenchyma. On liver angio-CT it is sometimes possible to visualize the bile ducts in the central scar. At angiography, FNH is hypervascular and homogeneous. On MR scans, in T1-weighted SE sequences, the condition is isointense or slightly hypointense, whereas on T2-weighted pulse sequences it is slightly hyperintense; the central scar is hypointense on T1, and hyperintense on T2, weighted scans. As we have no pathognomonic patterns but only orientative ones, a reliable differential diagnosis with hepatocellular adenoma (HA) and fibrolamellar hepatocellular carcinoma (FL-HCC) must be based on biopsy or cytology or, even better, histology. The differential diagnosis is nevertheless necessary because, while FNH does not usually require a surgical approach but only a radiological follow-up, both HA (due to possible bleeding and degeneration) and FL-HCC require surgery.

[Evaluation of the role of mammography and echography in breast diseases in a controlled caseload]

Data concerning patients who underwent mammography and breast ultrasonography and then breast surgery were collected and analyzed with a computer archive system. In previous papers the authors reported both design and implementation of the computer archive and analyzed the results concerning uncontrolled collected data; in the present paper data concerning controlled cases are evaluated, distinguishing between symptomatic and asymptomatic cases. Asymptomatic patients represented 92% of the whole evaluated population. However only one third of the patients who underwent surgery for breast cancer was included in this group. Breast cancer was discovered in 65% of the patients who underwent diagnostic procedures and then surgery because of a palpable nodule. This percentage was lower (52%) in asymptomatic patients. Mammographic accuracy was about 90% in symptomatic patients and 81% in asymptomatic patients. Breast ultrasonography was performed as a subsequent step and always detected the lesion when palpable. Its sensitivity was 86% in asymptomatic patients. In patients who underwent surgery the false positive rate for cancer was higher with ultrasonography (59%) than with mammography (45%). Focal dysplasis were responsible for the majority of false positive diagnoses with both procedures. However, the false positive rate is low referring to the whole investigated population and is reshuffled by guided bioptic procedures. Ultrasonography was a useful tool when mammography had limitations: in fact ultrasonography detected a focal lesion in all patients with a surgically proven cancer and a previous negative mammography. The sets of data available from the continuous updating of the computer archive immediately clarified the differences between symptomatic and asymptomatic patients and stressed the diagnostic capabilities of the different procedures.

[Echography and cytology in the study of spreading pathology of the salivary glands]

The contribution of the combined use of US and cytology is evaluated in the diagnosis of masses in the salivary glands and adjacent structures. US had 87.2% sensitivity in locating the mass; its accuracy in defining both physical structure and benign/malignant nature of the lesion was 91% and 74%, respectively. Thus US, after demonstrating a lesion, does not always allow the exact definition of its characteristic. In many of these cases, other imaging modalities do not help either. In our series of cases, cytology allowed an unquestionable diagnosis to be made in 87.2% of cases, and the combined use of US and cytology rose the figure to 97%. The only limitation is the evaluation of the deep extent of large masses: in such cases CT or, if available, MR imaging are recommended.

[The definition and realization of a computerized archive for radiological data of scientific interest]

The general requirements are analyzed of a system designed to acquire and manage radiological data of scientific interest. These requirements consist in: easy implementation, to develop the system in the same environment where it is going to be used; easy use, to avoid excessive needs and resources for the system to be managed in practice; reduced implementation cost, in terms of resources required for its implementation; user-oriented approach, in the sense of meeting the radiologists' requirements, and flexibility, for the system to be an effective tool for the widest range of possible applications. Two actual applications of this general approach are then discussed, one relative to breast investigations data, and the other to digital procedures (US, CT, DSA, MR) data. For each application the software tools employed are analyzed, together with the archive structures and the used codes, the collecting data procedures and the programs. For the breast investigations archive the possibility of obtaining standard periodic reports is pointed out. These reports summarize the global department activity in this area during selected periods (six months-one year). They allow interesting clinical conclusions to be drawn. As for the digital procedures archive, the possibility is stressed of searching different combinations of scientific data out of tens of thousands of cases in just a few minutes.

[Tha data management of a breast radiology section via a computerized archive]

In the Institute of Radiology of the University of Trieste, from January to December 1988, 7123 patients underwent breast diagnostic procedures following a screening program for breast cancer or in order to evaluate specific symptoms. The data relative to this series of cases were collected and processed using the system described in a colleague's paper. Several sets of data became available concerning the percentage distribution of the techniques employed, their main indications, the distribution of pathological features in relation to different indications, the diagnostic value of combining different techniques, and the suggestions based on the findings collected. Both mammography and US proved to be able to solve the great majority of diagnostic problems, sometimes also as a tool to guide bioptic procedures. Other techniques (galactography, pneumocystography, CT) were devoted to specific diagnostic problems. The results are interesting in view of their clinical, epidemiological and management implications.

[High-risk focal breast lesions in echography and mammography]

Proliferative breast diseases include a group of lesions which occupy an intermediate position between benign and malignant lesions and are extremely likely to develop into carcinomas. The authors studied 81 patients who had been surgically biopsied on the basis of mammographic and/or US findings. In 33/81 (40.7%) of them proliferative lesions were diagnosed at histology. Mammography was able to identify 18/33 lesions (54.5%) versus US 26/33 (81.8%). On the basis of these findings, a group of patients at risk for cancer could be identified. As a matter of fact, proliferative lesions, especially those presenting with atypical hyperplasia, are associated with a higher risk of developing into carcinomas than those presenting with typical features. For these patients, the authors suggest more frequent clinical and instrumental screening.

[Role of ultrasonics in the diagnosis of subclinical carcinoma of the breast]

The authors report the results of a retrospective multicentric study concerning the sonographic diagnosis of subclinical breast cancer, 11,254 patients were examined by means of mammography, with last-generation mammographic equipment, and by means of real-time US with 7.5-10 MHz transducer. Fifty-seven subclinical breast cancers were identified and histologically confirmed. US detected 30/57 neoplastic lesions, versus mammography 47/57; in particular, US identified 10 cancers missed at mammography, while the latter detected 27 malignant lesions missed at US. Mammographic accuracy in the early detection of breast cancers was 82.4%, while US accuracy was 52.6%. Mammographic false negatives were due to opacity of the glandular parenchyma. US false negatives presented at mammography as microcalcifications (67%), lesions less than 1 cm phi (22%), and indirect signs (11%). The results of this study demonstrate the important role of US in women with radiographically-dense parenchymal patterns, but confirm the superiority of mammography in the detection of subclinical breast cancer.

[Ultrasonic-guided fine-needle biopsy of osteolytic lesions]

Percutaneous biopsy of lytic lesions of the bone, in the past pertaining to orthopedic surgeons, has now become a part of interventional radiology. Fluoroscopic guidance has simplified its execution. US does not, under normal conditions, allow an accurate examination of the skeleton; on the other hand, when the bone tissue is replaced by soft tissue, US can easily demonstrate the presence of a tumefaction, caused by a lytic lesion, and determine its characteristics. Eleven patients with lytic lesions (recognized on plain film) underwent US. The lesions were demonstrated. In such cases, biopsy is essential to define their benign or malignant nature, in the latter case if primitive or metastatic, and their histology as well. US is a simple guide to the biopsy of noncorticalized lytic lesions, and it offers consistent advantages over fluoroscopic guidance--i.e. it is easier to perform, it requires no X-ray exposure, it provides with three-dimensional images, the guide is performed in real time, and a choice of the most appropriate (non-necrotic) areas is possible.

[Evaluation of expansive myelo-vertebral pathology using different radiologic modalities, magnetic resonance excluded]

The authors review their personal experience in tumors of the spine and the spinal cord, based on 30 cases evaluated with plain x-ray film of the spine, plain Computed Tomography (CT), myelography and myelo-CT. The value of both plain film of the spine and CT in tumoral lesions involving the skeleton is assessed; however, as far as nervous structures are concerned myelography and myelo-CT are necessary. Both myelography and myelo-CT showed high sensitivity (96%), thus allowing the definition of intra- extra-thecal extension of the tumor, and its relationships with the spinal cord and surrounding structures. Myelo-CT turned out to be extremely useful in myelographic stop: the upper extension of the lesion could be defined in 85% of cases. However, the contribution of myelography and myelo-CT was relatively limited when positive findings were present at CT. The evaluation of the density of the lesions proved to be of limited value since no significant differences could be recognized in different tumors. Finally, a diagnostic protocol is proposed for patients with spinal neurologic symptoms, based upon the clinical level of the lesion.

[Mammographic diagnosis based on oblique projection. Personal experience]

It is widely known that an early detection of breast cancer, when still asymptomatic, can improve the prognosis. Screening is thus suggested, and mammography should be the methodology of choice. Therefore, we tried to evaluate the best mammographic approach to the screening of breast cancer. Since January 1st, 1986, we have changed our mammographic procedures: the results obtained have been compared with those previously acquired. Through the evaluation of the different parameters we observed that: 1) the best results in patients screened for the first time can be obtained by using the cranio-caudal and the oblique mammographic views; 2) in the follow-up the oblique view can be used alone--which must then be compared with the oblique view of the first exam. This new mammographic approach makes it possible for us to reduce the exposure-dose to the patient and to the population, as well as the time and the cost of the screening. Moreover, the number of examinations can be increased by 20%. These results are extremely interesting, since mammography is now as sensitive as ever.