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INTRODUCTION: Given the growing importance in clinical practice of transrectal real-time sonoelastography of the prostate, it is important to define normal patterns correlated to volume growth and reconsider the technical problems. MATERIALS AND METHODS: We selected a sample of 100 men aged 30 to 87 with prostate volumes ranging from 20 to 100 cc. Strain images were obtained using an end-fire convex probe. The elasticity patterns of the various anatomical zones of the prostate were compared with the volume. RESULTS: The peripheral zone showed intermediate elasticity in 100% of cases regardless of the volume. We found some rare small areas of more limited elasticity in 23% of cases, among patients over 40. The posterior side of the central zone exhibited intermediate elasticity, and relative inelasticity was observed on the lateral side and at the base in 79% of cases. The entire central zone appeared compliant in 15% of cases and inelastic in 6%. The transition zone findings were stratified according to gland volume. When the volume was less than 45 cc, the transition zone was elastic in 67% of cases, inhomogeneously inelastic in 22%, and uniformly inelastic in 11%. In glands larger than 45 cc, the appearance was mainly elastic in 31% of cases, inhomogeneously inelastic in 57%, and uniformly inelastic in 12%. CONCLUSIONS: Real-time elastography can distinguish the elastic properties of the prostate and define the normal patterns associated with increases in gland volume.

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Primary and metastatic tumors of the liver can be treated successfully with transcatheter chemoembolization (TACE) during selective arterial catheterism. Arteritis is a possible referred side effect which can lead to tortuosity of the arteries, stenosis and occlusion of vessels. In our hospitals 117 consecutive patients were treated with TACE from January 1990 to December 1992; 61 patients were affected by hepatocellular carcinoma (HCC) and 56 were affected by metastases from colorectal carcinoma. Each patient received from 1 to 4 treatments at monthly intervals using epirubicin/Lipiodol ultrafluid (E/LUF) or a mixture of epirubicin and mitomicin C (MC)/LUF and followed by gelatine sponge injection in the hepatic artery. Selective angiography performed 30-62 days after the first chemoembolization showed artery stenosis in 7 patients and thrombosis in 2 cases related to toxic arteritis due to chemoembolization. Reports about arteritis during TACE treatments are discussed.

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Ninety-five percutaneous renal biopsies under ultrasound guidance were performed on 89 patients with nephrologic diseases. Accurate diagnosis was reached in 93% of cases at the first biopsy, and the figure increased to 100% after a second biopsy. The use of 18 and 16 gauge needles allowed correct histological diagnosis in 95% of patients, and satisfactory histology in the extant 5%. US guidance and the use of 18 and 16 gauge needles reduced the complications related to renal biopsy: in fact, severe hematuria occurred in 2 cases only.

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Transcatheter embolization for uncontrollable haemorrhage from pelvic organs was performed in 27 patients (12 women, 15 men) as an aid or alternative to surgery. The advantages and peculiarities of different embolic materials employed, and methods for managing intractable haemorrhage are discussed.

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Thirty seven patients with lymphomatous disease were studied to detect abdominal lymph nodes involvement by means of lymph nodes scan with 99Tcm-sulfur-microcolloid, ultrasounds scans, lymphangiographies. Lymphangiography was considered as reference standard in patients which explorative laparotomy was not performed in. Isotopic method demonstrated high sensitivity, despite low specificity. Opposite results were obtained by ultrasounds. We concluded that isotopic abdominal lymph nodes scan is a clinically valuable test, if negative, while ultrasounds are, if positive. Both methods, specially if associated, proved quite useful in restaging after therapy, where important parameters are low risk and stress for the patients, easy execution, low costs.

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Lumbar epidural venography was used as the examination of choice in the investigation of suspected disc herniation in 270 patients. Compression or occlusion of an epidural and/or radicular vein at the disc level is the most significant venographic abnormality. In 110 patients operated on, the reliability of lumbar epidural venography was equal to 97.2%.

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This article describes the normal radiological anatomy of the epidural veins whose understanding is necessary for the correct interpretation of venographic studies. Three ways of achieving adequate visualization of the epidural venous plexus are described. Experience with 80 cases is reported; a comparison has been made among the degree of visualization of the epidural venous plexus, the length of time, the cost and the amount of radiation received by the operator and patients during the performance of each technique. Preference is expressed for simultaneous injection of contrast media via two needles introduced into right and left femoral veins.

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In 50 patients subjected to aorto-femoral arteriography, the examination was carried out with and without the addition of 1 cm3 of 2% lidocaine per 10 cm3 of contrast medium; in 43/50 lidocaine led to a more or less notable reduction in pain without side-effects.

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