Ultrasound pattern of a rare skin disease: multiple miliaryosteoma cutis

PURPOSE

Multiple miliaryosteoma cutis (MMOC) is a rare nodular skin disease, characterized by tiny bone nodules in the dermis and subcutaneous tissue, presenting clinically as multiple normochromic papules and nodules, usually on the face. We described the case of MMOC of the face in a woman, ultrasonically evaluated with very high frequency probe.

MATERIALS AND METHODS

A 45-year-old patient with multiple papules, 3-5 mm in diameter, grouped in the frontal region. Skin ultrasound examination, cutaneous biopsy and laboratory evaluation were performed.

RESULTS

High-frequency ultrasound showed the presence of multiple hyperechogenic linear and roundish structures, associated by hypoechogenic shadow. The histology revealed a normal orthokeratotic stratified epithelium with fragment of mature lamellar bone localized at level of the reticular dermis. Laboratory evaluation was normal. According to the clinical, pathological, laboratory and instrumental analyses, a final diagnosis of miliaryosteoma cutis (or primary osteoma cutis not associated with Albright's hereditary osteodystrophy) was made.

CONCLUSION

In case of multiple papules of subcutaneous tissue, the diagnosis of MMOC, although rare, should be considered and high-frequency sonography, identifying the calcifications, suggests diagnosis.

Preoperative advantages of HF sonography of pilonidal sinus

Pilonidal sinus is a not infrequent disease, probably due to a disontogenetic origin. Histologically, there is a pseudocystic formation in the subcutaneous adipose tissue, containing some hair bulbs. It usually presents a recurring inflammatory course. The pathologic formation does not normally have thick wall, being made up of thin epidermal epithelium, without internal vascularisation and with frequent subcutaneous fistulae. Even though the clinical diagnosis is rather easy, surgery may prove, on the contrary, a demanding task, with a high incidence of recurrence and complications. An adequate knowledge of the condition and its development, with a precise definition of the margins of the lesions, may simplify the surgery, reducing the chance of recurrence or complications. The use of echography in the diagnosis of this disease, in our cohort of 72 patients, has always provided valuable information. In particular, 13 and 18 MHz linear probes and 20 MHz mechanical array have been used, and the latter in particular for the evaluation of fistolous cavities/passageways under the skin. Results. In all our cases, echography has demonstrated pseudocystic formations, without real walls, with fairly high levels of internal echoes, compared to the hair follicles, or, more rarely, true macrocalcifications with one or more cavities/passageways near the skin, without internal vascularisation, according to the histological findings. Echographic data are rapidly obtained, and can prove useful for surgeons for a a better management of patients. Conclusion. We consider diagnostic echography, using high frequency probes, useful for the anatomical definition of this disease, as well as to enable better surgical management.

Role of contrast-enhanced ultrasound in early diagnosis of psoriatic arthritis

BACKGROUND

Radiographic examination (Rx) is still the best method to obtain an accurate diagnosis of psoriatic arthritis (PsA). Nevertheless, ultrasound (US) examination of the potentially involved joints has started to play a leading role. The sensitivity and specificity of a scan can be determined by contrast enhancement in the diagnosis of arthritis during PsA in comparison with basal US with MRI.

METHODS

Our study was made on 22 uninformed patients showing clinical suspicion of PsA. The patients were submitted to clinical evaluation, Rx, US with and without contrast enhancement and MRI. The parameters evaluated by basal US were effusion, synovial hypertrophy, positiveness to color power Doppler signals and bone erosion.

RESULTS

Contrast-enhanced US (CEUS) seems to amplify small alterations previously detected by US and, moreover, increases the diagnostic confidence in cases of suspected symptomatology with a negative diagnosis. Finally, CEUS appears to have a concordance of almost 100% with the results of MRI with contrast enhancement.

CONCLUSION

US appears to be an effective method for detecting the alterations in bone outline and soft tissues, such as synovitis. Furthermore, US provides useful information concerning the evolution of vascularization and the dynamic behavior of tendons.

Percutaneous vesiculodeferentography in the diagnosis of male infertility: A review of our results and the data reported in the literature

Vesiculodeferentography was used in the past to evaluate suspected cases of obstruction of the seminal ducts. Over the years, numerous attempts have been made to improve the technique used to perform this examination and to render it less invasive. Its use is currently indicated in selected cases, where it is combined with functional studies like seminal tract washout and followed by immediate interventions to correct the alterations revealed. Vesiculodeferentography includes collection of the contents of the seminal vesicles, which can later be used in vitro assisted fertilization procedures.

Sonographic features of penile-gland lithiasis

A 52-year-old man presented with a small, red, tender swelling near the penile frenulum at the lower edge of the base of the glans. Lower urinary tract symptoms were absent. Ultrasonography revealed a stone lodged in the distalmost portion of the glands of Littre. Combined with a good knowledge of penile anatomy, use of this simple imaging tool allows reliable diagnosis of even the rarest cases of penile pathology.

Ultrasound and psoriatic arthritis - Review of the literature and general considerations

The authors review the recent literature on the use of ultrasonography in psoriatic arthropathy. The results are discussed in light of the authors' experience and with reference to technological advances and processes.

The association of colour flow Doppler sonography and conventional ultrasonography improves the diagnosis of thyroid carcinoma

OBJECTIVE

In the present study, we compared the results of conventional ultrasonography (US) and colour flow Doppler sonography (CFDS) with those of US guided fine needle aspiration biopsy (FNAB) and of pathologic staging of resected thyroid nodules, to assess the relative importance of US and CFDS in discriminating malignant thyroid nodules.

SUBJECTS AND STUDY DESIGN

We retrospectively reviewed records of 230 patients submitted to US-guided FNAB before surgery for solitary, not hot thyroid nodules. Before US guided FNAB, they were examined with conventional US and CFDS. Conventional US evaluated nodule size, echogenicity, presence of halo sign and microcalcifications. CFDS evaluated the vascular pattern classified as types I, II and III. Twenty-seven patients with inadequate cytology were excluded from this study (11.7%).

RESULTS

Two hundred and three patients underwent surgery. At histology a thyroid carcinoma was found in 36 patients (17.7%) and a benign nodule was observed in 167 patients (82.3%). We did not find any difference in cancer prevalence between nodules with a primary tumour size < or =1 cm and those >1 cm (17.6 vs. 17.7%; p = 0.99). A solid echo texture was not statistically significant to suggest malignancy (p = 0.32). Microcalcifications were seen in 83.3% (30/36) of malignant nodules and in 33.5% (56/167) of benign nodules. These results were statistically significant (p < 0.0001). The type III flow as determined by CFDS was a statistically significant criterion to suggest malignant disease (p < 0.005). The most predictive findings of malignancy on conventional US was the combination of microcalcifications plus the absence of halo sign (sensitivity 75%, specificity 71.9%, p < 0.0001). The combination of an absence of halo sign on conventional US and a type III pattern on CFDS presented the higher sensitivity (83.3%) for malignancy with a specificity of 43.7%. Microcalcifications on US in combination with a type III CFDS pattern showed a lesser sensitivity (80.6%) with an improved specificity (75.4%). In our opinion, the better balanced combination of US and CFDS features was the absence of halo sign plus microcalcifications and a type III CDFS pattern (sensitivity 72.2%, specificity 77.2%).

CONCLUSIONS

The combination of conventional US and CFDS provides benefits in increasing the screening sensitivity and accuracy in distinguishing malignant thyroid nodules.

Sonographic evaluation of clinically occult in-transit and satellite metastases from cutaneous malignant melanoma

PURPOSE

Our purpose was to assess the potential of ultrasonography (US) in the detection of in-transit or satellite metastases.

MATERIALS AND METHODS

Following a review of the relevant literature, we present the results of a retrospective study based on 2,000 malignant melanoma patients with complete case records. Of these, we selected 600 patients who had a thick melanoma (>1 mm) at presentation but were clinically free of in-transit or satellite melanoma metastases during follow-up. All patients underwent periodic clinical and imaging investigations, as well as US examination of the site of the surgical wound and surrounding soft tissues.

RESULTS AND DISCUSSION

US raised the suspicion of in-transit or satellite metastases in 63 patients. A total of 95 lesions were identified. Average lesion diameter was 0.7 mm, and only four were larger than 1 cm. All suspected lesions were confirmed by surgery, follow-up or US-guided fine-needle aspiration (FNA) with 22-gauge needles using a freehand technique and exploiting the capillarity principle. In this series, there were apparently no false positive or false negative US results although inclusion criteria precluded correct evaluation of possible false negatives. Minimum lesion diameter allowing sonographic detection appears to be around 0.4 mm. US features of in-transit metastases have been well documented. They usually appear as solid lesions, hypoechoic relative to the surrounding subcutaneous fat and with relatively well-defined and regular contours and good US transmission. Internal structure is fairly homogeneous, and sometimes millimetresized fluid areas can be appreciated inside. Larger metastatic lesions may exhibit internal vascular signals at power Doppler imaging. These findings in dermatological sonography are almost exclusive of metastases but may also be seen in glomangioma, which, however, has intense intralesional vascularity. US-guided FNA plays an important role in diagnosis of metastases from malignant melanoma. Of the 32 nodules that were cytologically sampled, a definitive or most probable diagnosis of metastasis was made for nodules with a mean diameter of 0.7 mm (minimum 0.5 mm).

CONCLUSIONS

Sonography of soft tissues surrounding the original site of a malignant melanoma should be more widely used and associated with US-guided FNA biopsy.

Small hyperechogenic nodules in thyroiditis: usefulness of cytological characterization

Small hyperechogenic nodules occurring in thyroiditis frequently raise the question of their nature requiring additional evaluation. Given the scarcity of the studies addressing this issue, we have investigated whether cytopathological analysis of fine needle aspirates (FNA) of these lesions may be of diagnostic relevance. In this preliminary study, we submitted to cytopathological analysis 10 nodular lesions as well as the normal counter-lateral tissue. In none but one of the cases analyzed, the cytopathology was able to detect differences between the hyperechogenic models and the hypoechogenic parenchyma suggesting that these lesions bear no-clinical relevance. Therefore, FNA of these nodules is not advisable and should be limited to those with defined at risk clinical features.

Elastofibroma dorsi: ultrasound pattern in three patients

Elastofibroma dorsi is a rare benign tumor with a prevalence in the female population. The tumor is composed of adipose and fibrous tissue. It is typically localized at the tip of the scapular and is more frequently bilateral. Even if there are only very few reports on this topic, the incidence of the tumor seems to be less rare than expected. Elastofibroma dorsi was identified in 1961 and the first study using diagnostic ultrasound technique was published in 1996, however, since then no other major work has been produced. The purpose of the paper is to present three cases of elastofibroma dorsi, all studied by ultrasound imaging, including color and power Doppler, and by fine needle aspiration biopsy. Furthermore, in one case i.v. contrast media (Levovist) was used, and in two cases a CT and MRI evaluation was also made. Surgical excision was not performed in any of the cases. The relevant follow up was performed by clinical and ultrasound tests. In all the cases the ultrasound pattern of the elastofibroma dorsi was very similar to the surrounding muscular tissue, and neither a clear cleavage surface nor a specific vascular pattern could be evidenced. The tumor was very difficult to define from the surrounding tissue, except for a more evident coarse pattern and the same happened for the CT and MR, where a layered pattern of fatty tissue was noted. In this small cohort the tumor was mainly monolateral. The ultrasound investigation, integrated with color and power Doppler permitted a correct diagnosis, which was confirmed by the fine needle biopsy. Therefore, the less expensive ultrasound diagnosis, as a major method of screening for elastofibroma dorsi, would seem to be a reasonable proposal.

Our experience in transrectal ultrasonography and biopsy in carcinoma of the prostate

The Authors present a short review of the literature comparing transrectal ultrasound of the prostate (TRUS) and ultrasound guided biopsy and the results of 694 consecutive prostatic biopsies from their cohort. All the biopsies were US guided with an endorectal biplanar 5 MHz probe and transperineal samples were carried out with an 18 G needle (cutting length 22 mm) over the last 4 years. The histological exam showed 187 prostates affected by cancer while 112 had only inflammation. The operator's opinion, based on ultrasonography and integrated with a digital rectal exam (DRE) and a prostate specific antigen (PSA) blood test, was correct in 80% of the cases, with 90% sensitivity and 70% specificity. The positive prediction rate was 74% and the negative prediction rate was 89%.

High frequency ultrasound in the preoperative staging of primary melanoma: a statistical analysis

High frequency sonography has been shown to be a useful tool in the preoperative staging of malignant melanoma. In the present study sonometric and histometric data concerning tumour thickness were compared, using appropriate statistical methods, in order to assess the accuracy of ultrasonography. From December 1997 all pigmented lesions suspected of being melanoma were preoperatively assessed by a 20 MHz ultrasound B scan. The results of these ultrasound examinations were compared with histometric data. Pearson's correlation coefficient and absolute and relative differences were used for statistical analysis. Of the 261 examined lesions, 193 were malignant melanoma. A high correlation between sonometry and histometry was computed (r = 0.95), with an absolute difference of 0.32 +/- 0.03 mm (mean +/- SEM) and a mean relative difference of 27.2% (95% confidence interval 23-31.4%). The highest correlation was found in melanoma > or = 1.51 mm thick and the lowest correlation in melanoma < or = 0.75 mm. In conclusion, the high accuracy of this technique in the preoperative staging of malignant melanoma would offer a basis for defining the surgical margins of > or = 0.76 mm thick lesions. The limited accuracy of sonometry in the preoperative staging of thin melanoma < or = 0.75 mm has emerged by applying adequate statistical methods.

[The imaging quality of the ureteral intramural tract in the adult male. A comparison between suprapubic and transrectal echography]

PURPOSE

US is usually considered of little help in studying the ureters because it only shows proximal and distal tracts. The distal ureter is also difficult to study with most of the other imaging methods. Transrectal probes improve depiction of the intramural and pelvic tracts of the ureter, as well as image quality, dramatically providing good results in a short time. The first and, to our knowledge, the only report on this procedure has been Holm's (1994), where the author reported good results though in a small series. For years we have used transrectal US, performed for prostate studies, also to examine intramural ureters and have obtained good results in a short time. Thus we decided to compare the transrectal with the transabdominal approach.

MATERIAL AND METHODS

We examined 92 randomly selected male patients with various urologic conditions but no ureter involvement using 3.5 MHz convex and 5.0 MHz biplane transrectal probes. Image quality was rated on an arbitrary scale (0-4) and then submitted to statistical analysis.

RESULTS

Transrectal images were clearly superior to transabdominal ones (p = 0.012) and particularly, ureters were depicted in 93% versus 60% of cases, respectively. The amount of urine in the bladder appears to play a major role (the greater the amount the worse the image quality), while ureter depiction is independent of body habit and bladder squeezing.

CONCLUSIONS

Our results are clearly superior to Holm's. Also, considering that the transrectal examination requires a short time, is cost-effective and little invasive, we believe that this method can play an extremely important role in lower ureter studies.

[Plantar fibromatosis: ultrasonography results]

INTRODUCTION

Plantar fibromatosis, or Ledderhose's disease, is a fibrous proliferation arising within the plantar fascia end exhibiting typical clinical nodular features. The lesion appears as a firm single thickening or a nodule, occasionally painful, localized to the medial portion of the sole of the foot. This unusual condition has not been extensively studied with US and very little has been written about it.

MATERIAL AND METHODS

In 1998-99, six patients with plantar fibromatosis were submitted to US with 13 MHz linear array and 20 MHz mechanical annular array probes. All patients were examined in prone recumbency with the probe positioned on the sole of the foot. Only some of them were subsequently submitted to surgery.

RESULTS

Plantar fibromatosis exhibited an almost pathognomonic pattern and US proved to be a quick, noninvasive and cost-effective technique to confirm clinical diagnosis. The nodule is typically single and isoechoic, with maximum diameter of about 1 cm, inhomogeneous internal structure and few thin hyperechoic septa. The nodular fibrous proliferation adheres with the major axis along the plantar fascia; it exhibits clear-cut margins and US beam transmission is good. No calcifications or fluid collections are seen within the nodule. Color and power Doppler show no flow inside.

CONCLUSIONS

US is an adequate tool for the study of plantar fibromatosis.

[Lymphadenopathy as specific ultrasonography index of subacute thyroiditis. Preliminary data]

INTRODUCTION

We report the preliminary results of a study on the importance of juxtajugular and supraisthmian lymph node enlargement at US as a sign of occult subacute thyroiditis.

MATERIAL AND METHODS

We examined patients submitted to thyroid US for noninflammatory thyroid conditions and for positive familiarity and studied the presence of supraisthmian and juxtajugular lymph node enlargement. The patients were then divided into two groups: the clinical history, antibody titer and symptoms were studied in group A (patients with enlarged lymph nodes) and the antibody titer, symptoms and US findings were studied in group B (patients with a history of thyroiditis).

RESULTS

Fifty-nine of 600 patients were allocated to group A and 25 of 600 to group B. Of the former 59 asymptomatic patients (10% of the total), 29% had supraisthmian and 85% juxtajugular lymph node enlargement, with some patients positive at both sites. Forty-seven patients (80%) had subacute thyroiditis (33 of them with positive antibodies and 23 with a clinical history); we had 12 false positives. Twenty-two of 25 group B patients (91%) had supraisthmian (40%) or juxtajugular (83%) lymph node enlargement: 3 patients with no enlarged lymph nodes had an over 3-year history of low antibody titers.

DISCUSSION

Forty-seven of 600 (8%) asymptomatic patients who had been never examined are or were affected with subacute thyroiditis. Ninety-one per cent of all thyroiditis patients had supraisthmian or juxtajugular lymph node enlargement, more frequently the latter than the former.

CONCLUSIONS

Supraisthmian and/or juxtajugular lymph node enlargement appears to be a very useful US sign of subacute thyroiditis, even though these data need confirmation from larger series of patients.

[Role of high-definition and high frequency ultrasonography in determining tumor thickness in cutaneous malignant melanoma]

PURPOSE

We investigated the predictive capabilities of high frequency, high resolution ultrasound (US) in the preoperative assessment of tumor thickness in cutaneous malignant melanomas. This evaluation is a valuable help for correct surgical planning.

MATERIAL AND METHODS

December 1997 to August 1998, we studied with US over 120 pigmented skin lesions and collected the data, including the final histologic diagnosis, of 78 of them, which make our series. Sixty-six of 78 lesions were histologically defined as cutaneous malignant melanomas with superficial spread and the other 12 as melanocytic nevi. All examinations were carried out with an Esaotebiomedica AU 5 Harmonic scanner equipped with a 20-MHz annular array probe and a linear 13-MHz probe; B-mode, color and power Doppler images were always acquired.

RESULTS

The statistical analysis of the comparative US and histologic measurements of tumor thickness showed very good agreement, with a high Pearson's coefficient (R: .93). However, US frequently underestimated the actual thickness relative to histology, which is in contradiction with previous literature reports. We could study with US the melanoma in situ, which has never been described before. Last but not least, low-thickness melanomas had very few color and power Doppler signals.

CONCLUSIONS

US is the correct tool for the preoperative assessment of the thickness of cutaneous malignant melanomas because it provides high agreement with histologic data even in lesions thinner than 1 mm.

[Decubitus calcifications of the soft tissues. Comparison between radiology and echography]

In the past, several obstacles hindered the study of decubitus calcifications in soft tissues--i.e., poor prognosis, difficult patients investigation due to their poor health and, finally, unsufficient information yielded by conventional radiology. However, special radiographic techniques and US (with 7.5 MHz probes) allowed satisfactory results to be obtained. US permits the more accurate definition of the site of calcifications, better demonstration of the calcifications with poor calcium content and optimal depiction of structural changes of the muscular bundles following denervation or edema and of skin trophism changes. US limitations, besides those strictly related to the method itself, are: gross calcifications with large posterior shadowing not allowing the deep layers to be investigated, the need of an extremely qualified operator and of a detailed description and, finally, the fact that the exam is long, difficult and stressful to the operator and painful to the patient. In conclusion, US provides both the surgeon and the clinician with useful information and can thus be employed as a routine test, with the additional advantage of not employing ionizing radiations.

[Seminal vesicles: echographic findings in 244 subjects. Evaluation of anatomic data and correlations with pathologic prostatic-vesicular parameters]

Over a 2-year period (1989-90), about 400 cases were examined (out of nearly 2,500 US examinations of the prostate), 244 of which had subsequent bioptic, surgical or autoptic confirmation. This paper reports the anatomic, clinical and pathologic data relative to the seminal vesicles of 244 subjects who underwent transrectal US of the prostate for different clinical indications. Our biometric values were slightly different from those reported in literature, the latter being based on autoptic findings. Agenesis and monolateral ectopia were confirmed to be extremely rare: 4 cases only (1.6%) in our series. A typical finding was the nearly perfect symmetry; in size and structure, of the two seminal vesicles in the same subject; as a matter of fact, a loco-regional pathologic condition was detected in all the patients (14) with asymmetry. A hundred per cent agreement was observed between the US patterns of the seminal vesicles and the prostatic patterns in case of acute/subacute prostatic inflammation involving also the 2 glands: this parameter can be used to follow the clinical course of the inflammatory process.

Transperineal vesiculodeferentography under ultrasound control: first experiences

Vesiculodeferentography (VDG) plays an important role in diagnosing male infertility and staging of prostatic cancer; the techniques of performing the examination are, today, well codified: 1) retrograde, by endoscopic cannulation of ejaculatory ducts; 2) anterograde, by cannulation of the deferent duct surgically prepared at the scrotum. In order to avoid the difficulties of the first method and the risks in the second (like stenosis and fibrosis of the deferent duct) we propose a new simple and safe method based on the direct transperineal puncture of the seminal vesicle under direct echographic control with a transrectal probe. We have studied 16 patients, mainly in order to stage prostatic cancer; the procedure was easy to perform, well tolerated and without consequences at seminal level. It required only 30 minutes, without anaesthesia and with a very low cost. The method permits a clear visualisation of anatomical structures and of possible pathologies with particular reference to vesicular invasion by a prostatic cancer.

[Echo-guided needle biopsy of the thyroid. An assessment of 52 thyroid neoplasms found in 1042 consecutive patients]

The authors report on a series of 1,043 fine-needle biopsies of the thyroid performed under US guidance; the patients had been selected for thyroid pathologic conditions. Fifty-two neoplasms were observed (46 papillary carcinomas, 1 medullary carcinoma, 2 follicular carcinomas, and 3 metastases), which had been detected by cytology and confirmed by histology or autopsy. The authors focus on 46 cases of papillary carcinoma: their US features were studied which, through a correlation of variables, allow a quick and "safe" recognition of the type of carcinoma (papillary carcinomas account for nearly 60% of thyroid neoplasms). Tumor echogenicity and outline, and the presence/absence of calcifications were evaluated: in most cases, papillary carcinomas presented as focal lesions (alone or associated with other goiter lesions), with irregular and blurred outline, no hypo/anechoic halo and, in about 1/3 of the cases, with calcifications and colliquative areas. In 17% of papillary neoplasms, metastases to loco-regional nodes were observable at US; in 3 cases the carcinoma did involve a loco-regional node but there were no US signs suggestive of it. The incidence of neoplasms on the total of fine-needle biopsies is 4.9%, while in a previous series of 3,038 fine-needle biopsies, without US guidance, on clinically detectable lesions, the figure was about 2%.

[Color Doppler in the diagnosis of malignant prostatic neoplasia. Preliminary results]

In the field ultrasonic diagnosis the application of color code to the duplex Doppler signal is without doubt the most up-to-date method. The common knowledge according to which all heteroplastic structures need a large quantity of O2 and provoke the formation of new vessels with the angiogenesis factor, with particularly rapid, and tumultuous fluxes due to the presence of shunt, is the basis for the use of color doppler in research on neoplasia in the initial phase. The authors submitted 11 patients considered at risk, to an echocolor Doppler study of the prostate, with a transrectal biplane probe of MHz. The exclusive application of ultrasonography grey scale, permitted the diagnosis of malignant neoplasia in 5 of these subjects. The following "color" exploration led to a cancer diagnosis in 10 patients. A bioptic check carried out through transperineal way color guided allowed the diagnosis of 8 'adenocarcinomas' and 1 undifferentiated CA.

[Transrectal echography and simultaneous uroflowmetry in the study of male urination. Considerations on 254 consecutive cases]

The authors report on a series of 254 consecutive male patients who underwent transrectal US, sometimes combined with uroflowmetry, for the study of micturitonal phase. 170 patients were studied with both techniques. In 118 patients, there was complete agreement between the two methods about presence and degree of flow obstruction; partial disagreement was observed in 48 patients and complete disagreement in 4. On 44/52 patients with partial/complete disagreement diagnostic cystouretrography was performed. Our results demonstrate high agreement between the two techniques, except in case of micturition deficit with columnar hypertrophic bladder and in obstructive pathologic conditions of anterior urethra.

[Ultrasound-guided prostatic biopsy using biplanar transrectal probe. Our experience]

In the last three years we performed more than 200 echo-guided prostatic biopsies using different probes. Recently, thanks to the availability of a bi-planar transrectal probe we have developed a technique that resulted simple rapid well accepted by the patients and above all able to center small prostatic nodules. We have studied with this technique 96 patients performing 120 biopsies. For the biopsy we used a 19 G cutting-needle introduced under local anaesthesia parallel to the probe (linear array) when the needle is on the target we turn on the axial view and we check the position with respect to the center of the lesion, then, returning to the sagittal view we perform 1 to 3 biopsies for microhistological and cytological examination. With this method we have reached a better accuracy of diagnosis.

[Calcifications of the prostate: a transrectal echographic study]

Prostatic lithiasis is a well know phenomenon. It has little clinical significance and is not easily shown by conventional radiography, which has poor sensitivity and specificity. The authors have studied 612 patients with both suprapubic and transrectal US in order to 1) assess US sensitivity and specificity and 2) report the frequency, spatial distribution, number and features of prostatic calcifications with special emphasis on differential diagnosis between prostatic neoplasms and chronic prostatitis. The authors have also studied the relationship between morphology and symptoms and the results agree with those reported in the scanty literature. The authors conclude that the parameters studied are directly related to age, except for a younger group with clear evidence of genital inflammation. The authors emphasize the impossibility to correlate morphology of prostatic calcifications with pathologic conditions: there are no specific symptoms clearly connected with calcification even though the inflammation is often associated with calcifications.

[Peyronie's disease. Ultrasonic evaluation]

Peyronie disease, or Induratio Penis Plastica, is characterized by the presence of one or more fibrous plaques at the albuginea penis, on the cavernous bodies or on the intercavernous septum. First of all, Induratio Penis Plastica etiology is described, and its clinics and therapy. Past imaging methods are then considered (i.e. conventional radiology, xerography), and current ones (i.e. conventional radiology, cavernosography, CT and US). The authors report on their 4-year (1983-1987) experience with US in 62 males. Various different probes were employed, especially small-part 7.5 MHz probes. The results are similar to those reported in international literature. The use of high frequency probes allows the evaluation of focal hypoechoic lesions even in the early phase of the disease, thus helping make therapy more effective.

CT of ischemic infarctions in the territory of the anterior choroidal artery: a review of 28 cases

The purpose of the present study was to examine the incidence, causal factors, and anatomic localizations of infarction in the territory of the anterior choroidal artery. We studied 28 patients who had CT evidence of infarction in this territory. The affected structures taken into consideration were the posterior limb of the internal capsule, the retrolenticular portion of the internal capsule, the internal portion of the globus pallidus, and the lateral thalamus. Three conclusions are drawn: that ischemic infarcts in the territory of the anterior choroidal artery are rare, representing 2.9% of all cerebral ischemic lesions in our material; that the incidence of a possible embolic origin is significant; and that the posterior two-thirds of the posterior limb of the internal capsule and the retrolenticular segment are the more frequently affected structures, and conversely, that the medial pallidus and the thalamus are less often involved.