The purpose of this prospective study was to evaluate the sensitivity of mediastinal sonography compared with computed tomography (CT) and chest radiography in the detection of mediastinal tumors. The sonograms, CT scans, and chest radiographs of 182 patients were interpreted blindly by three observers, and the results were compared. The proportion of diagnostic sonographic examinations varied for the different mediastinal compartments from 85% (subcarinal region) to 96% (supraaortic region). The sensitivities of sonography and chest radiography, respectively, for each compartment, with CT as the reference method, were as follows: supraaortic region, 98% and 67%; paratracheal region, 89% and 69%; aorticopulmonary window, 81% and 62%; prevascular region, 92% and 46%; subcarinal region, 69% and 31%; pericardial region, 100% and 67%; posterior mediastinum, 6% and 6%; and paravertebral region, 11% and 44%. These results show that sonography is superior to chest radiography in the diagnosis of mediastinal tumors. In certain mediastinal regions (supraaortic, pericardial, prevascular, and paratracheal), sonography is so sensitive that CT and magnetic resonance examinations may be obviated in patients with equivocal radiographic findings.

To explore the mechanism underlying the effects of the somatostatin (SST) analogue octreotide in Graves' ophthalmopathy (GO), we investigated the expression of SST and of SST receptor (sst [1][2][3][4][5] ) genes in primary cultures of fibroblasts established from retroorbital tissue of GO patients and of control subjects. We determined also SST specific binding sites by competitive binding of [ 125

Aims: To evaluate retinal nerve fiber layer (RNFL) thickness in eyes with Graves’ orbitopathy (GO), in eyes with ocular hypertension (OHT) and in a control group of healthy eyes. Methods: Observational, controlled cross-sectional study. We evaluated all patients with primary open-angle glaucoma (POAG) and all patients with GO and intraocular pressure >23 mm Hg in primary position examined from March 2006 to June 2007. Forty apparently healthy patients (80 eyes) were enrolled as a control group. Complete ophthalmic evaluation, visual field (VF) examination with the Humphrey Visual Field Analyzer and RNFL thickness measurement with optic nerve tracking optical coherence tomography (ONT-OCT; OCT/SLO, OTI, Toronto, Ont., Canada) were performed. Results: Among 116 eyes with POAG [58 patients, 32 males, 26 females, mean age 62 (46–71) years], RNFL was reduced in 87 eyes (75%, p = 0.05) when compared with the control group, and a good correlation was found between RNFL thickness and VF abnormalities (Spearman’s ρ 0.822; p = 0.001). Among 60 eyes [30 patients, 12 males, 18 females, mean age 56 (50–69) years] with GO and OHT, nonglaucomatous diffuse abnormalities of the VF were detected in 44 eyes (73.3%, p = 0.03), while RNFL thinning was present in 14 eyes (9 patients, 23.3%, p = 0.03). No correlation was found between RNFL thickness and VF abnormalities (Spearman’s ρ 0.365; p = 0.02). No significant differences in RNFL pattern were present between the group with GO, OHT and RNFL thinning and the group with POAG. Conclusions: In patients with GO and OHT, evaluation of RNFL thickness with ONT-OCT may represent an objective diagnostic technique for detecting optic neuropathy.

The radiolabeled somatostatin (SST) analog octreotide accumulates within the orbits of active Graves' ophthalmopathy (GO), and octreotide and lanreotide have been proposed to treat this disorder. It is still unclear which retroorbital cells the SST analogs target. Lymphocytic infiltration of retroorbital tissues is a peculiarity of GO, and labeled octreotide could accumulate at specific sites on retroorbital-activated lymphocytes. The accumulation of radiolabeled analogs is due to the interaction with specific cell surface SST receptors. Five subtypes of somatostatin receptors (SST1-5), member of the G protein-coupled, seven-transmembrane superfamily, are described. It still unknown which SST subtype is expressed in retroorbital activated lymphocytes. The aim of this study was to evaluate the expression of SST1-5 genes in lymphocytes recovered from retroorbital tissues obtained from patients with GO undergoing orbital decompression. Cultured phytohemagglutinin-stimulated lymphocytes from retroorbital blood samples, drawn during orbital surgery in five patients with GO and in two control patients without autoimmune or thyroid diseases and without orbital inflammatory conditions, were also studied. RT-PCR of total RNA extracted from lymphocytes was performed using primers for SST1-5 and, as internal control, for glyceraldehyde-3-phosphate dehydrogenase. All SSTs transcripts were found in lymphocytes both from GO retroorbital tissues and blood samples. The levels of expression of SST1, -2, and -4 mRNA were higher than those of the SST3 and -5 transcripts. In the lymphocytes from control subjects, the SST subtypes with high affinity for octreotide were barely found. The presence, even if at different concentrations, of all SST1-5 receptors in retroorbital lymphocytes from GO shows that they are targeted by SST analogs and could explain the effects described in GO patients treated with SST analogs.

Percutaneous biopsies of mediastinal tumors were successfully performed under sonographic guidance in 14 of 21 patients. In 10 of 11 malignant lesions, malignancy was determined by means of cytologic and histologic examination of the specimens obtained. A histologic diagnosis was reached in seven patients with malignant mediastinal tumors, including all four cases of Hodgkin lymphoma. Mediastinal biopsy under sonographic guidance is a technically simple, rapid, and accurate procedure, but its application is limited to tumors of the anterior mediastinum.