Hypoechogenic Areas Research Articles

Ultrasonographic changes of major salivary glands in primary Sjögren's syndrome. Diagnostic value of a novel scoring system

To reveal typical ultrasonographic (US) changes in major salivary glands associated with Sjogren's syndrome (SS) and to determine the diagnostic value of a novel US scoring system. In 218 consecutive patients with suspected SS, US of both parotid and submandibular salivary glands was performed besides the regular diagnostic procedure following the American-European Consensus Group criteria of 2002. Five US parameters were assessed: echogenicity, inhomogeneity, number of hypoechogenic areas, the hyperechogenic reflections and clearness of the borders of the salivary gland. The grades of these five parameters for all four salivary glands were summed. The final US score ranged from 0 to 48. SS was established in 68 patients. The remaining 150 subjects, in whom SS was not confirmed, constituted our control group. All five US parameters were significantly associated with SS. The patients with SS had significantly higher US scores than those not diagnosed with SS (P<0.01). Setting the cut-off US score at 17 resulted in the best ratio of specificity (98.7%) to sensitivity (58.8%). Well-defined US changes in the major salivary glands summarized in our novel scoring system were typical of SS patients. Advanced structural changes found on US imaging almost invariably represent SS salivary gland involvement.

Subacute Thyroiditis Developed in Identical Twins Two Years Apart

A 34-year-old woman was referred to our hospital complaining of sore throat and arthralgia. She had low-grade fever, tachycardia, and goiter with tenderness. Laboratory data revealed thyrotoxicosis and tests for acute inflammatory markers were positive. Thyroidal radioactive iodine uptake was below normal. Ultrasonography of thyroid revealed mild thyroid enlargement and hypoechogenic areas consistent with tenderness. Subacute thyroiditis was diagnosed and prednisone was administered. Two years later, her identical twin sister, who lives separately, was referred to our hospital because of neck pain, low-grade fever, and palpitation. She exhibited the same clinical picture as her twin sister, and was also diagnosed as having subacute thyroiditis. Although the cause of subacute thyroiditis remains unclear, viral infection has been implicated in the onset of subacute thyroiditis in genetically predisposed individuals. We could not identify the viruses, but heterozygotes for HLA-B35, which has been reported to be linked with subacute thyroiditis, were found in the twins. This supports the suspicion that genetic factors, including this HLA haplotype, play a critical role in the onset of subacute thyroiditis.

Assessment of the thymus at echocardiography in fetuses at risk for 22q11.2 deletion.

An absent or hypoplastic thymus is common in patients with 22q11.2 deletion (del22q11.2). We sought to determine whether fetal echocardiography could identify absence of the thymus as a diagnostic tool in pregnancies at risk for fetal del22q11.2. We evaluated the fetal thymus in 16 consecutive pregnancies at risk for fetal del22q11. Fourteen of the fetuses had a conotruncal cardiac lesion, one had a twin with a conotruncal lesion, and in one the mother had a diagnosis of del22q11.2. The fetal thymus assessment was performed by an individual who was not aware of the del22q11.2 status of the fetus. By 2D imaging, the thymus was identified in the anterosuperior mediastinum as a subtle hypoechogenic area. In nine cases, the thymus was demonstrated prenatally and none had del22q11.2. However, in one case the thymus was only seen on follow-up fetal echocardiography. In six cases, the thymus could not be identified and all six had del22q11.2. In one additional case, analyzed retrospectively, the thymus could not be assessed. The status of the thymus was confirmed on postnatal echocardiography or autopsy in 11 of the 15 cases assessed prenatally. Our study suggests that fetal echocardiography can assess the thymus in most cases at risk for del22q11.2. This information may be useful in counseling women/couples who decline amniocentesis or who are awaiting amniocentesis results.

Long-term ultrasonographic features of the Achilles tendon after rupture.

To assess the long-term ultrasonographic appearance of rupture of the Achilles tendon. We examined 70 patients at an average of 63 months (range 10-120 months) after rupture of the Achilles tendon. We assessed the patient's contralateral tendon and also performed ultrasonography on the Achilles tendon of 70 age- and sex-matched controls. We recorded the maximum transverse anteroposterior diameter, the presence of intratendinous alterations, and the presence of intratendinous calcification. The average maximum anteroposterior diameter of the ruptured tendon was 11.7 mm (SD = 2.10). The patients' normal tendons measured an average of 5.4 mm (SD = 0.9), and there was an average measure of 4.9 mm (SD = 0.5) (p = 0.0001) in the controls. There was no difference in the maximum anteroposterior diameter of the ruptured tendon depending on the method of treatment (conservative, open repair, percutaneous repair). Seventeen patients exhibited areas of hypoechogenicity in their ruptured tendon, two patients had areas of hypoechogenicity in their unruptured contralateral tendon, and 10 patients had calcification in their ruptured tendon. The anteroposterior diameter of the ruptured tendon was significantly greater than the nonruptured contralateral. However, when compared with a group of individually age- and sex-matched controls, the patients' contralateral tendons had significantly greater maximum anteroposterior diameter and had a greater prevalence of intratendinous alterations. This difference may represent a background of subclinical tendinopathy that may predispose to rupture.

The Possible Role of F-18 FDG Positron Emission Tomography in the Differential Diagnosis of Focal Pancreatic Lesions

To compare the diagnostic values of different methods for the differentiation of malignant from benign pancreatic lesions. In 22 patients with focal pancreatic lesions, the carbohydrate antigen (CA) 19-9 level was measured; abdominal ultrasound (US), computed tomography (CT), endoscopic retrograde cholangiopancreatography (ERCP), and F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) were performed; and the value of these methods were analyzed for their use in cancer diagnosis. Malignant lesions were identified in six patients and verified by surgery or clinical follow-up. The CA 19-9 level was elevated in four of the five patients examined (sensitivity, 80%). In all six cases, US and CT revealed hypoechogenic and hypodense areas (sensitivity, 100%). In one patient, ERCP was unsuccessful but yielded true-positive results in three others (sensitivity, 60%). The sensitivity of FDG PET was 100%. Sixteen focal cases of pancreatic disease proved to be benign. The CA 19-9 level was elevated in four of them (specificity, 73%). Hypoechogenic and hypodense areas were evident on US and CT in eight patients. The specificity of CT was 50% (8 of 16 cases). The specificity of US was 47% (7 of 15 cases). The specificity of successful ERCP was 92%. Fourteen negative FDG-PET results were truly negative. In two patients, however, the PET findings proved to be falsely positive (specificity, 88%). FDG-PET is an effective tool to differentiate malignant from benign focal pancreatic lesions. In persons with focal pancreatic hypoechogenic or hypodense lesions detected by CT or US and an elevated CA 19-9 level, FDG PET should be the next step in the diagnostic strategy.

Sonographic findings of tensor fascia lata tendinopathy: another cause of anterior groin pain.

To describe the sonographic appearances of the normal tensor fascia lata (TFL) origin and to describe the sonographic changes that were present in the TFL of a group of athletes presenting with anterior groin pain. The sonographic appearances of the TFLs of 40 healthy asymptomatic volunteers were evaluated. The TFLs of approximately 200 patients aged between 16 and 55 years presenting with anterior groin pain were evaluated in the course of routine sonographic assessment of the hip. Twelve abnormal TFLs were identified in 12 patients aged between 16 and 53 years. A retrospective review of the appearance of the normal and abnormal tendon with respect to its overall size and echotexture was made. The normal TFL has a thin ribbon-like appearance with a clearly defined fibrillar pattern and a mean anteroposterior (AP) size of 2.1 mm (range 1.5-3.1 mm). In the patient cohort the TFL typically appeared enlarged and contained a cone-shaped area of hypoechogenicity based on the iliac crest within the deep fibers of the origin. The TFL origin was enlarged up to 2 1/2 times its normal size. The mean AP size of the abnormal TFL was 4.7 mm (range 3.1-7.0 mm). Tendinopathy of the TFL is a cause of anterior groin pain. Sonography can be used to depict changes in the TFL, confirming the diagnosis and assessing the severity of the tendinopathy.

F91The role of ultrasonography in the management of gestational trofoblastic disease: diagnostic, treatment and follow‐up modality

Since hysterectomy is no longer considered standard procedure in the treatment of malignant gestational trofoblastic disease (GTD), ultrasonography plays a major role in the detection of the myometrial involvement. The Ultrasonography is standardly used as one of the main diagnostic tools when GTD is suspected. It seems that the size of the mola is no longer considered predictive marker for malignant change. We demonstrate the role of ultrasonography as an excellent method in the treatment of presumed GTD particularly in the evacuation of possibly invasive mole or choriocarcinoma. The specimen for the diagnosis is obtained securely under the ultrasound supervision enabling us to control the diagnostic curettage and to prevent the possible uterine wall perforation. Together with serum hCG levels US and Doppler analysis are useful tools in the monitoring of the tumor regression in the course of chemotherapy. We demonstrate that possible ultrasonographic features of the tumor like intramyometrial signals and hypoechogenic areas (representing mainly arteriovenous malformations) may remain in the long term follow up of successfully treated GTD with negative hCG serum levels. Concluding that monitoring of serum hCG is of major clinical interest in the treatment of GTD suggesting the limited interpretation value of ultrasonographic finding.

THE ULTRASONIC DESCRIPTION OF POSTPUBERTAL TESTICLES IN MEN WHO HAVE UNDERGONE PREPUBERTAL ORCHIOPEXY FOR CRYPTORCHIDISM

We provide a sonographic description of postpubertal testicles in patients who have undergone prepubertal orchiopexy with placement of a suture through the tunica albuginea. Testicular ultrasound was performed in men who had undergone prepubertal testicular fixation for cryptorchidism using a suture passed through the tunica albuginea. Comparison was made to the sonographic appearance of cryptorchid testicles not secured with a fixating suture through the tunica albuginea. The operative report for each patient was reviewed with specific attention to use and type of suture material, and age at orchiopexy. Ultrasonography was performed on 22 men in whom a tunica albuginea fixating suture was placed during orchiopexy for cryptorchidism. Average patient age at orchiopexy was 5.6 years and median time from orchiopexy to this examination was 14.8 years. Right cryptorchidism existed in 64% of the men. No significant difference was noted in size between the 2 testicles in any patient. Ultrasonography did not identify any parenchymal abnormalities. A tunica albuginea calcification with posterior shadowing on the side of fixation was noted in 32% of patients, of whom 3 had calcified areas evident on physical examination. An area of subtunical hypoechogenicity was noted in 14% of patients. All tunical abnormalities were associated with the use of chromic suture. The remaining 12 patients (54%) had normal sonographic and physical examinations. The control group comprised 6 men who underwent orchiopexy without a fixating suture through the tunica albuginea. These men were examined identically and no sonographic abnormalities were noted in the tunica albuginea or testicular parenchyma. At a median of 16 months no patient had been diagnosed with testicular cancer or had a change in testicular self-examination. Tunica albuginea calcifications and hypoechogenic cysts are common ultrasonic findings in men who have undergone orchiopexy using a suture passed through the tunica albuginea. Parenchymal lesions should not be considered secondary to this procedure and must be treated as de novo abnormalities. These changes seem to be induced by the use of a fixating suture through the tunica albuginea.

Topical retinol improves cellulite

A group of 20 women with moderate cellulite of the thighs were treated twice daily on one side for 6 months with a 0.3% stabilized retinol cream while the opposite side was treated with the vehicle, following a double-blind format. Objective measurements included ultrasound measurement of thickness using a 20 MHz B-scan, and laser Doppler velocimetry for blood flow. The panelists and a dermatologist estimated the degree of improvement on a global scale. Of 19 subjects, 13 rated the retinol side as more improved, 7 registering good effects. The dermatologist's estimates were largely congruent with those of the subjects. There was also a marked reduction in the density of hypoechogenic areas on the retinol sides, from 53% to 18% of black pixels on image analysis. Blood flow measurements were unchanged on the vehicle sides but increased significantly on the retinol sides. Thickness measurements by ultrasound scan were unchanged on the vehicle sides but increased significantly on the retinol sides, from 1.44 to 1.60 mm. Retinol may be viewed as a prodrug which the skin metabolizes to retinoic acid. The beneficial effects of retinol are consistent with previous reports of increased synthesis of glycosaminoglycans and collagen.

Reproducibility in Ultrasonic Characterization of Carotid Plaques

Background and Purpose: Echolucent carotid plaques compared with echogenic plaques could carry a significant risk of transient ischemic attacks and strokes, but the reproducibility of new ultrasonic methods has not yet been proved. The objective was to evaluate interobserver and intraobserver agreement in characterizing the carotid plaques studied by both B mode imaging and color Doppler imaging, which is the only ultrasonic method available for recognizing anechoic lesions. Methods: Fifty-three carotid plaques greater than 40% in diameter were selected from four centers and simultaneously analyzed by 9 observers. Five types of plaques were defined by their echo structure: class I = uniformly anechogenic, class II = predominantly hypoechogenic with >50% hypoechogenic area, class III = predominantly echogenic with >50% echogenic area, class IV = uniformly echogenic, class V = unclassified plaques. The luminal surface was characterized as either 1 = regular, 2 = recess of more than 2 mm in depth and width, or 3 = unclassified. Agreement of these variables was calculated by using the kappa index, agreement proportion and an intraclass correlation coefficient. Results: Interobserver reproducibility was only fair for type I (kappa = 0.47) and for the luminal surface (class 1, kappa = 0.52 and class 2, kappa = 0.41). Agreement proportion was 0.51 in hypoechoic plaques and 0.64 in the determination of the regular surface. Mean intraobserver agreement was fair (kappa = 0.47 ± 0.1) for plaque echogenicity to good (kappa = 0.63 ± 0.19) for surface. Conclusion: This study shows that the semiquantitative classification, first developed by Gray-Weale, then by Nicolaides, could be improved, thus giving rise to a new outlook in the debated field of ulcerations.

Prenatal diagnosis of testicular torsion.

A case of the prenatal diagnosis of testicular torsion at 39 weeks' gestation is presented. The affected testicle was observed as a small rounded area of hypoechogenicity with a peripheral echogenic ring without hydrocele. The appearance was suggestive of the chronic phase of testicular torsion. The neonatal genital exploration confirmed the diagnosis.

Tendon pathology in long-standing achillodynia: Biopsy findings in 40 patients

We evaluated biopsy specimens from the Achilles tendon in 40 patients with long-standing achillodynia and an ultrasonographic widened tendon with hypoechogenic areas. We used a standardized protocol to assess the general tendon pathology score of paraffin-embedded specimens stained with HE. Stereologic measurement of the volume density of glycosaminoglycan (GAG)-rich areas, stained with the Alcian blue (pH 2.5)/periodic acid Schiff method (AB/PAS) was performed. 14 specimens obtained at autopsy served as reference material. Abnormal fiber structure and arrangement, focal variations in cellularity, rounded nuclei, decreased collagen stainability and increased non-collagenous extracellular matrix were seen in all biopsy specimens. Slight histopathological changes were noted in half of the controls. Increased vascularity was present in two thirds of the patient specimens and in one third of the controls, and signs of perivascular hemorrhage, as evidenced by hemosiderin deposition in 6/40 of the patients, but in none of the controls. The volume density of GAG-rich areas was higher in the patients 0.47 (0-0.86) than in the controls 0 (0-0.07). Changes in the fiber structure and arrangement, as well as increased amounts of interfibrillar GAG, appear to be characteristic morphological features in Achilles tendons with long-standing achillodynia and ultrasonographic widening. These findings may indicate that achillodynia is due to local disturbances in connective tissue metabolism or circulation or to both.

Hepatic trauma in children: long-term follow-up.

The purpose of this report is to assess the role of long-term clinical and hepatic ultrasound (US) follow-up in children who sustained blunt liver trauma. Forty-three children with blunt hepatic injury were prospectively studied between 1976 and 1994 in our institution. Four patients died (9%). Fourteen children (52%) were operated upon and 13 (48%) were treated conservatively. Twenty-seven patients were recalled for a long-term echography (US) with a mean time span of 6 years after trauma. The physical examination and the liver tests were normal in all patients. The US aspect of the liver was abnormal in 22% of our cases, showing hypoechogenic areas and anomalies of the biliary tract in four patients (11%). Cholelithiasis secondary to hemobilia was demonstrated in 2 patients. Cholecystectomy was performed in one patient because of posttraumatic strictures of the biliary tract. All patients with US anomalies of the liver and biliary tract were clinically asymptomatic and had normal liver tests. We recommend a follow-up US in children having sustained blunt hepatic injury about 6 months after the trauma. If no cholelithiasis or alteration of the biliary tract is present, no other follow-up procedure seems necessary.

Frequent involvement of the internal cuff segment in CAPD peritonitis and exit-site infection--an ultrasound study

The extent of involvement of the subcutaneous Tenckhoff catheter tract in CAPD peritonitis and catheter-related infections is of major therapeutic importance. By definition, both peritonitis and exit-site infections do not involve the catheter tract. However, diagnosis of these infections as well as the more sinister tunnel infection is based mainly on clinical signs. We examined the usefulness of ultrasound examination (US) of the catheter tract in delineating catheter-related (exit-site and tunnel) infections, and their relationship to each other and to peritonitis. CAPD patients with no evidence of peritonitis or catheter-related infections for 6 months prior to examination served as controls. US were performed by one of two experienced radiologists using the Acuson 128XP/10 scanner with a 7-MHz linear transducer. A positive US was defined as an area of hypoechogenicity (indicative of fluid collection) >2 mm in width along any portion of the catheter tract. Findings were localized into segments(S) as follows: S1, limited to external cuff; S2, intercuff segment adjacent to the external cuff; S3, intercuff segment adjacent to the internal cuff; S4, limited to the internal cuff; and S5, involvement extending throughout the catheter tract. Between March 1993 and January 1995, 39 CAPD patients, all with a double-cuff straight Tenckhoff catheter with the exit site situated above the point of entry into the peritoneum were studied. A total of 56 US were performed divided among 26 episodes of peritonitis, four tunnel infections, 13 exit-site infections,and 13 controls. There were 30 positive US distributed among 16 peritonitis, four tunnel, eight exit site infections and two control patients. The two positive controls went on to develop peritonitis within 1 month of the US. The majority of the US findings (13/16 in episodes of peritonitis and 5/8 exit site infections were localized to segment 4, that is, to the internal cuff region. Apart from a significant increase in width in all infected segments versus a normal tunnel, no differences in size were seen between peritonitis, exit-site, or tunnel infections, nor were there any differences in size and localization in these infections when comparing the offending organism (Gram-positive, negative, or culture negative). We conclude that peritonitis and exit-site infections are frequently accompanied by involvement of the catheter tract. The localization of infection to the internal cuff region in cases of exit-site infection probably occurred as a result of downward migration along the catheter tract. This supports the notion that ideally the exit site should be pointing caudally or that the peritoneal catheter have a swan-neck configuration. With regard to peritonitis, infection within the peritoneal cavity appears to extend and involve the internal cuff region. Thus both the internal and external cuffs do not seem to pose an effective barrier against the spread of infection.. Based on our data, we recommend that US be performed as a routine investigation in all cases of exit-site infection and in cases of refractory or relapsing peritonitis.

Pre‐treatment of nickel test areas with sodium lauryl sulfate detects nickel sensitivity in subjects reacting negatively to routinely performed patch tests

A fair % of patients with a clinical history of nickel allergy show negative patch test results. To improve the response rate to NiSO4 5% pet. patch tests, a testing procedure utilizing pre-treatment of the test area by a 24-h application of sodium lauryl sulfate (SLS) was introduced. 46 women with a clinical history of nickel sensitivity, who exhibited negative reactions to nickel sulfate 5% pet. patch tests, were studied. Patients underwent 6 patch tests on adjacent sites on the volar surface of the forearms. 4 patch tests were performed with a 72-h application of 40 mg nickel sulfate 5% pet. While 1 of these patch tests served as control, 3 test areas underwent 24-h pre-treatment with 40 microliters SLS, 1 with 0.1% and 2 with 0.5% solution. To evaluate differences in the reactivity to SLS plus nickel sulfate related to the site on the forearm, 0.5% SLS pre-treatment was performed both on a proximal and on a distal test site. At the 72-h evaluation, 19 subjects out of 46 showed positive reactions to nickel sulfate 5% pet. at skin sites pre-treated with 0.1% SLS, whereas 23 patients reacted positively at 0.5% SLS pre-treated areas. Echographic values of skin thickness and of hypo-echogenic dermal areas at positive pre-treated nickel test areas were higher than at control test areas, confirming the clinical evidence of an increased response to NiSO4 after SLS pre-treatment. The inflammatory reaction, as evaluated clinically and echographically, was much higher at distal skin areas (0.1% SLS and distal 0.5% SLS) than at proximal 0.5% SLS ones.

Familial prostatic adenocarcinoma in the A.U.S.L territory of Imola

From 1987 to 1992, over 6,000 men aged between 50 and 79 years underwent mass screening for early diagnosis of prostatic carcinoma. They were also given an “epidemiological” questionnaire drawn up by a Urologist, which included information regarding civil status, fertility, working conditions, eating and smoking habits as well as tumours in the family. With regard to the latter, it appeared that 11% of patients with cancer have a positive family history against 2.2% in healthy men and 1.8% in individuals with benign prostatic hypertrophy. In order to investigate this aspect, 46 next of kin (brothers, sons) of patients with prostatic carcinoma (mean age 60 years, range 44–76) were enrolled in the study and subjected to DRE, TRUS and PSA assay. Patients with an alteration of one or more of the above-mentioned parameters (6 patients) underwent an echoguided biopsy (of nodule or normal). Only one (aged 52 years, PSA 12.1, DRE negative, TRUS small hypoechogenic area, prostatic volume 80 cc) had grade 2 PIN. Prostatectomy performed on the patient in another hospital showed that he had fibromyo-glandular hyperplasia. Results are discussed and compared with those reported in literature.

Pretreatment of the test area with 1‐day occlusion improves the response rate to NiSO4 5% pet. Patch tests in subjects with a positive history of nickel allergy

A group of 58 women, aged 18 to 51 years, with a clinical history of nickel allergy, who exhibited equivocal or negative reactions to nickel sulfate 5% pet. patch tests performed on the skin of the back, were recruited consecutively from the patch test clinic from September 1993 to June 1994. In order to improve the response rate to NiSO4 5% pet. patch tests, a testing procedure utilizing pretreatment of the test area by 1-day (24-h) occlusion was introduced. Patients underwent 2 patch tests on adjacent sites of the volar surface of both forearms. 3 of the patch tests were performed with 40 mg nickel sulfate 5% pet., whereas a control test was carried out by occluding with an empty chamber. 2 of the nickel sulfate test sites were pretreated with 1-day occlusion performed with an empty chamber. A visual grading system and echographic measurement were used to quantify the responses 30-40 min after patch test removal. Echographic evaluations were carried out using a 20 MHz B-scanner. Measurement of skin thickness and determination of the hypoechogenic dermal area, both considered to be parameters of inflammation, were used to evaluate the intensity of the allergic reaction. At the 3-day (72-h) evaluation, 19 subjects out of 58 clearly showed positive reactions to nickel sulfate 5% pet. at pre-occluded skin sites. Moreover, values of skin thickness and of 0-30 areas at positive pre-occluded nickel test areas were higher in respect to control test areas, confirming clinical evidence of increased response to NiSO4 after occlusion.

Ultrasound of the Achilles tendon after surgical repair: morphology and function.

Ultrasound is a well established method for the examination of the Achilles tendon. The objective of the study was to provide answers to the following questions: What ultrasonographic structural changes are long lasting after surgical repair? How important is ultrasound with regards to the functional evaluation of late results? 60 patients were examined at an average 11 years (2-19) after surgical repair of Achilles tendon rupture. In only four patients sonographic morphology of the tendon was according to the non-injured side. A variety of distinct basic alterations in ultrasound morphology was found: a hypoechogenic ribbon ventrally to the dorsal paratenon (n = 40), spots of hypoechogenic areas in the tendon (n = 18), dishomogeneous hyperechogenicity with preservation (n = 12) or dissolving (n = 22) of its fibrillar components along the longitudinal axis. In most of the cases the paratenon was thickened or could not be differentiated. In the dynamic ultrasound examination gliding mechanism of the achilles tendon was limited in 41 patients. Extensive functional subjective and objective parameters of all patients were evaluated in an Achilles tendon score. The results were rated as excellent (n = 18), good (n = 29), satisfactory (n = 12) and poor (n = 1). There was no statistical correlation between ultrasound morphology and clinical outcome. Therefore, it was concluded that ultrasound examination is able to reveal long-lasting alterations in echogenicity of the tendon but is only of limited value with regards to evaluation of the functional results after surgical repair.

Sodium hydroxide-induced irritant dermatitis as assessed by computerized elaboration of 20 MHz B-scan images and by TEWL measurement: a method for investigating skin barrier function.

Sodium hydroxide-induced irritation was studied in 34 volunteers, by means of 24-h patch testing at different concentrations, and by a 10-min testing procedure employing 0.1 mol/l NaOH. As a supplement to subjective evaluation of skin changes, assessments of test areas by TEWL measurement and sonography were performed at 24, 48 and 72 h. After 24-h patch testing, instrumental evaluations showed an increase in the extension of the hypo-echogenic dermal area and in TEWL, whereas a 10-min NaOH application induced a decrease of the dermal and epidermal reflectivity and an increase in TEWL. Twenty-four hour patch testing with 4% NaOH allowed a classification of subjects into two categories: subjects who reacted normally and hyper-reactors. Hyper-reactors showed an enhanced inflammatory response and a more pronounced barrier function damage, as assessed clinically and instrumentally by decreased dermal reflectivity, and by higher postexposure TEWL. Subjects with a more marked inflammatory response to 4% NaOH also showed greater TEWL increases during the short-term testing procedure employing 0.1 mol/l NaOH. Moreover, these subjects were characterized by higher baseline TEWL values, indicating that cutaneous reactivity to NaOH is at least partly correlated to impaired stratum corneum function, which is inadequate to effectively prevent compounds from penetrating the skin.

PRIMARY KIDNEY TUMORS BEFORE AND AFTER RENAL TRANSPLANTATION1,2

Three groups of patients were reviewed. Primary carcinomas were found in donors kidneys of 47 recipients. In 30 instances a tumor was present at harvesting. When a neoplasm was removed immediately pretransplantation or early posttransplantation there were no recurrences in 14 recipients. In another two instances, a tumor was not removed or was incompletely excised pretransplantation and both recipients died of metastases. Fourteen other patients received kidneys from donors in whom the opposite kidney had a malignancy. Thirteen remained tumor-free and one had allograft nephrectomy for rejection 3 months posttransplantation when a carcinoma was found. In 17 recipients an allograft neoplasm was not recognized at harvesting. In 9 it was discovered at graft nephrectomy an average of 3 months posttransplantation. In a tenth patient a hypoechogenic area, found on routine posttransplant ultrasonography, progressively increased in size and proved to be malignant. Another 7 patients developed metastases from renal carcinomas an average of 12 months posttransplantation. Preexisting carcinomas were found in 350 recipients. Seventy-one patients with incidentally discovered tumors had no recurrences no matter when nephrectomy was performed in relationship to transplantation. Of 279 patients with symptomatic renal tumors, 70 (25%) had recurrences, 63% of which occurred in patients treated < or = 2 years pretransplantation. De novo cancers were found posttransplantation in 256 recipients. Renal carcinomas were 4.6% of posttransplant cancers compared with 3% of tumors in the general population. In 222 patients their own diseased kidneys were involved, in 24 tumors occurred in the allograft, and in 10 cases the site was not stated. Development of neoplasia seemed to be related not to the immunosuppressive therapy but to the underlying cause of renal failure, especially analgesic nephropathy. A disproportionate number of carcinomas (15%) involved the renal pelvis, most likely because of prior analgesic abuse.