Abnormal Ultrasonography Findings Research Articles

Does Bisphenol-A play a role in the development of neural tube defects?

In this study, we aimed to evaluate BPA levels in the maternal serum and amniotic fluid of patients diagnosed with NTD. In addition, we wanted to investigate the relationship between neurodevelopmental defects, such as neural tube defects (NTD), and BPA levels. This prospective observational study was carried out at Bursa Yüksek İhtisas Training and Research Hospital between April 15, 2021, and April 15, 2022. The study consisted of 92 patients between the ages of 18-45 who had an amniocentesis at 15-22 weeks of gestation. The patients were divided into two groups according to the indications of amniocentesis. Group 1 contained the patients with abnormal maternal serum screening results or cell-free DNA results and abnormal ultrasonography findings (45 patients). Group 2 contained the patients with a pre-diagnosis of NTD (47 patients). The first 5 cc fluids and maternal serum samples taken during the amniocentesis procedure of all patients were delivered to the biochemistry laboratory. The BPA values between groups were compared. A statistically significant difference was found between the two groups in terms of amniotic fluid BPA levels (36.66 (19.00:82.00) and 39.62 (19.02-73.87)) and maternal blood BPA levels (22.26 (12.60-228) and 47.81 (12.89-228.39)). In cases with NTD, amniotic fluid BPA levels and maternal blood BPA levels were significantly higher than the control group. When AUC values were compared, the AFP numerical value was higher than the amniotic fluid and maternal blood BPA levels. Plastic, which is indispensable for modern life, may negatively affect fetal development in intrauterine life. The data in this study says that high maternal blood BPA may be associated with NTD.

Frequency of acute kidney injury in birth asphyxia at a Tertiary Care Hospital, Karachi.

ABSTRACT… Objective: To determine the frequency of acute kidney injury (AKI) in neonates presenting with birth asphyxia. Study Design: Cross-sectional study. Setting: Department of Pediatrics, National Institute of Child Health, Karachi. Period: December 2022 to May 2023. Material & Methods: A total of 159 neonates of both gender, aged between 7-28 days and having birth asphyxia were analyzed. Demographic features were recorded. The blood sample was collected in a sterile manner using 5 ml syringe and sent to the institutional laboratory for serum creatinine and electrolyte analysis. The frequency of AKI was noted. Results: In a total of 159 neonates, 95 (59.1%) were boys, The mean baseline serum urea and creatinine were 33.5±32.1 and 0.83±0.62 mg/dl respectively. AKI was noted in 65 (40.9%) neonates. Girls (p=0.035), relatively lower occipital frontal circumference (p=0.004), normal vaginal delivery (p<0.001), history of seizures (p<0.001), abnormal USG KUB (p<0.001), poor conscious level (p<0.001), higher birth asphyxia grading (p<0.001) and poor urine output (p<0.001) were linked with AKI. Mean baseline serum urea levels and serum creatinine levels were significantly raised among neonates who had AKI. Conclusion: The frequency of acute kidney injury among neonates having perinatal asphyxia was high. AKI was noted to have significant association with female gender, relatively lower occipital frontal circumference, normal vaginal delivery, history of seizures, abnormal ultrasonography findings, poor conscious level, higher birth asphyxia grading, and poor urine output at the time of admission.

To study ultrasound and chest X-ray findings and their role in the diagnosis of dengue fever in children.

Dengue fever is a fatal viral illness affecting almost all age groups and is seen in almost all tropical countries. Ultrasonography (USG) can be a useful tool for the assessment and diagnosis of dengue fever. The study aimed to evaluate X-ray and ultrasound findings in children with dengue fever. This was a prospective and cross-sectional study that was carried out in a hospital in Mumbai for over one year. All relevant data were collected, validated, and analyzed statistically on the software Epi Info 7. Abnormal X-ray findings noticed were pleural effusion, pneumonia, and bilateral nodular opacities. Pleural effusion and respiratory complications were more common in severe dengue (P < 0.05). Out of the 37 patients on whom USG was done, 33 (89.18%) had abnormal and 4 (10.81%) had normal USG findings. Of the 17 patients with dengue who showed warning signs, 16 (89.9%) had abnormal USG findings. Plasma leakage in the form of ascites and effusion was commonly seen. One hundred percent of patients with severe dengue had abnormal USG findings. The abnormal USG findings were more commonly detected between 5-7 days and were more commonly associated with IgG + IgM-positive serology. Ultrasonography is a good modality for the diagnosis and evaluation of dengue patients. Serial ultrasound should be done for the assessment and evaluation of said patients.

The Influence of Non-E. Coli or Extended-Spectrum β-Lactamase-Producing Bacterial Growth on the Follow-Up Procedure of Infants with the First Febrile Urinary Tract Infection.

To evaluate the effects of non-E. coli or extended-spectrum β-lactamase-positive (ESBL-positive) microorganism growth in the first febrile urinary tract infection (UTI) of infants on laboratory findings or renal parenchymal damage presenting the severity of inflammation, anatomic abnormalities defined by imaging studies, and recurrent UTIs in the follow-up period. The data of patients aged between 2 and 24 mo and followed up for at least 6 mo with febrile UTI guideline of the authors' pediatric-nephrology clinic, were retrospectively analyzed. Ultrasonography was performed in all the cases at the time of UTI and dimercaptosuccinic-acid(DMSA) at least 4mo after the infection. Voiding cystourethrography (VCUG) was performed only if ultrasonography findings were abnormal, the uptake deformity was detected in DMSA scan, or the patients experienced recurrent UTIs. The patients were grouped concerning E. coli or non-E. coli and ESBL-PB or non-ESBL-BP growth in the urine cultures. There were 277 infants followed up for 28.55 ± 15.24(6-86) mo. The causative microorganisms were non-E. coli in 73 (26.4%) and ESBL-PB in 58 (20.9%) cases. CRP values, pyuria, and leukocyte-esterase positivity were significantly higher in UTIs causedby E. coli compared to non-E. coli bacteria. All clinical and laboratory findings were similar between the ESBL-PB and non-ESBL groups, but abnormal ultrasonography findings were more common in non-E. coli group. E. coli causes more severe inflammation, but non-E. coli infections are more frequently associated with ultrasound abnormalities. However, ESBL production did not affect either laboratory or radiological findings in the present cohort.

Rapid Progression of Non-Alcoholic Fatty Liver Disease into Cirrhotic Liver in Trisomy 21 Patient: A Case Report and Brief Literature Review

Abstract Introduction/Objective Trisomy 21 (Down syndrome) is the most common chromosomal disorder. Among trisomy 21 patients in the pediatric setting, obesity is one of the most common conditions, with prevalence ranging from 23% to 70%. Trisomy 21 has several risk factors for obesity, including increased unfavorable dietary patterns, lower levels of physical activity, and other comorbidities. Epidemiologic studies found this increase in pediatric obesity along with an increased prevalence of non-alcoholic fatty liver disease (NAFLD). Furthermore, children with trisomy 21 have a higher prevalence of NAFLD than children without trisomy 21, even in the absence of obesity. As per literature, NAFLD is present in 64.3 percent of patients with Trisomy 21. Methods/Case Report We present a case of a 17-year-old female with trisomy 21 who was diagnosed with B-cell acute lymphoblastic leukemia (B-ALL) after being admitted due to abdominal pain and decreased appetite. The patient was found to have elevated liver enzymes with abnormal ultrasonography findings. MR images showed fatty liver infiltration with a hepatic fat fraction of 47%. Subsequently, a percutaneous liver biopsy was obtained. Microscopic examination showed minimal hepatic parenchyma with collapsed architecture replaced by abundant steatosis (approximately 90%). Portal triads showed mild lymphocytic inflammation and presence of neutrophils. No fibrosis was confirmed with the trichrome stain. She was then enrolled on AALL1731, a clinical trial for a therapy to treat B-ALL. A 4-month follow-up MR image showed hepatic steatosis. After 9 months, liver biopsy revealed cirrhotic liver along with portal lymphoplasmacytic inflammation, bile duct proliferation and mild macro vesicular steatosis. Results (if a Case Study enter NA) NA Conclusion This case report signifies the importance of histological evaluation of liver abnormalities to provide better treatment. It is vital to schedule close follow-ups in Trisomy 21 patient polpulation, because NAFLD can transform rapidly into a completely cirrhotic liver escpecially with acute lymphoblastic leukemia on chemotherapy. We also emphasizes early lifestyle modifications, including weight loss and proper diet.

Ultrasonographic evaluation of chronic shoulder pain after breast cancer surgery: single center, cross-sectional study

Chronic shoulder pain is a common complication in breast cancer patients after surgery. Chronic shoulder pain after breast cancer surgery was formerly considered as neuropathic pain, however the pathophysiology including structural damages has not been assessed comprehensively. We hypothesized that the structural change could be one of the cause of shoulder pain after breast cancer surgery and evaluated various ultrasonography findings of the shoulder in breast cancer patients with chronic shoulder pain. Patients who were suffering from chronic shoulder pain on unilateral side for at least 3 months after breast cancer surgery were enrolled from a single tertiary hospital. Demographic and clinical data were collected at the baseline. Articular and adjacent structures of both shoulders (painful and contralateral side) were evaluated by ultrasonography. The ultrasonography findings were compared between painful and contralateral sides. Logistic regression analysis was performed to determine the factors associated with abnormal ultrasonography findings. Fifty-two female patients (average age of 55) were enrolled. Significantly more abnormal ultrasonography findings were observed in the painful side than in the contralateral side [39 (75.0%) vs 11 (21.2%), P < 0.001]. The coracohumeral ligament was significantly thicker in the painful side than in the contralateral side (2.48 ± 0.69 vs 1.54 ± 1.25 mm, P < 0.001); adhesive capsulitis was also more frequent in the painful side [14 (26.9%) vs 0, P < 0.001]. Furthermore, patients with a history of breast cancer surgery on the ipsilateral side were associated with abnormal ultrasonography findings and adhesive capsulitis. This study is the first to evaluate ultrasonography in patients with chronic shoulder pain after breast cancer surgery. The results showed that ultrasonography could reveal several structural problems in these patients.

Does the placental strain ratio correlate with the umbilical artery Doppler values?

Objective: The aim of this study is to reveal whether there is any relationship between strain elastography (SE) values and Doppler ultrasonography (US) findings, and to investigate the availability of SE in early diagnosis of preeclampsia (PE). Material and Methods: The authors examined 21-24 week old patients who applied to this clinic for anomaly screening. Only 55 pregnant women with anterior or anterolateral placental placement were included in the study. Doppler US data and placental strain elastography values were compared statistically. Results: There was an inverse correlation between umbilical artery resistance index (RI) values and placental strain ratios. Discussion: Histopathological examination shows that, as a result of the increasing extracellular matrix proteins due to increased inflammation, elasticity in the placental tissue decreases, and this may lead to an increase in placental stiffness. Also it is known that, abnormal Doppler US findings are considered to be a weak positive predictor of placental insufficiency. Therefore the present authors compared Doppler US with placental elastography and found an inverse correlation between umbilical artery RI value and placental strain ratio. Conclusion: Placental elasticity can be used for placental abnormalities in addition to other methods, but further studies are needed to use placental elasticity as a positive predictive marker for placental insufficiency.

Clinical and microbiological profile of urinary tract infection in children less than five years of age

Background: Urinary tract infection (UTI) is a common bacterial illness of pediatric age group. UTIs, especially in young children, have non-specific signs and symptoms that can be undetected or misdiagnosed. Delaying diagnosis and treatment of UTIs may result in long-term renal complications. Objectives: The objectives were to study the clinical presentation of UTI, common uropathogens, and antimicrobial sensitivity pattern among children &lt;5 years of age. Materials and Methods: This is a hospital based prospective descriptive study which included 100 children &lt;5 years of age who presented with UTI over a period of 1 year. Detailed history,clinical examination, and laboratory investigations including urine analysis and culture were documented. Results: Out of the 100 children below 5 years who presented with UTI, 32% were below 1 year age. Male to female ratio in our study was 2.8:1. The most common presenting symptom was fever followed by crying during micturition. 92% of the cases had significant pyuria. Escherichia coli is the most common pathogen isolated (68%), followed by Klebsiella and Enterococcus. 62% had abnormal ultrasonography findings, most common being hydronephrosis (36%). Conclusions: The presentation of pediatric UTIs varies widely with ageand sex. Knowledge of the varied presentation of UTI, its risk factors and local antimicrobial sensitivity patterns are of great significance in preventing future complications in children.

Penile Doppler ultrasonography and elastography evaluation in patients with erectile dysfunction.

PurposeTo evaluate the relationship between erection grade, erectile function score, Doppler ultrasonography (US) indexes, and elasticity score (ES) according to Doppler US diagnosis in patients with erectile dysfunction (ED).Material and methodsReal-time strain type penile elastography was performed during penile Doppler US examination for 88 patients with ED. The diagnosis according to Doppler US was determined. Erection score according to the Erection Hardness Grading Scale was evaluated. A scoring for erectile function was performed with the International Index of Erectile Function (IIEF-5), and the Sexual Health Inventory for Men (SHIM) was defined. The relationships, according to Doppler diagnosis, of ES, IIEF-5 score, SHIM scale, and erection score were evaluated.ResultsAmong the patients, 50 (57%) had abnormal penile Doppler US findings. According to Doppler US findings, patients were classified as normal (n = 38), borderline for arterial insufficiency (n = 4), arterial insufficiency (n = 5), and venous insufficiency (n = 41). The lowest erection hardness grades and IIEF-5 scores were detected in patients with arterial failure. When compared to the normal group, in terms of ES, the arterial failure borderline group and venous failure group had lower scores, and the arterial failure group had a higher score. However, the only significant difference was obtained in the left cavernous body of the venous failure group.ConclusionsSonoelastography seems to add additional value for determination of stiffness of the penile cavernous body in routine evaluation of ED.

Assessment of Agreement between 99mTc-DMSA Renal Scan and Ultrasonography in the Evaluation of Renal Pathology in Children with Recurrent urinary tract infection

Imaging of urinary tract plays a very important role in children with recurrent urinary tract infection (UTI). Various imaging techniques are used and the imaging protocol in children with UTI continues to be a subject of debate. Most authors recommended combination of imaging. The children with recurrent urine infection may be at increased risk of renal parenchymal scarring, hypertension, impaired renal function and end stage renal disease. But early diagnosis and timely proper treatment has an excellent prognosis. 99m-Tc-dimercaptosuccinic acid (DMSA) renal scan and Ultrasonography (US) are routinely performed studies in children with recurrent UTI. If there is agreement between these two investigation procedures, they will be interchangeable, which will benefit the patient by one procedure instead of two. This will be less time consuming and cost effective. This analytical study was carried out at the National Institute of Nuclear Medicine and Allied Sciences (NINMAS), Bangabandhu Sheikh Mujib Medical University campus, Dhaka, from July 2013 to June 2014, for a period of 12 months. The objective of this study was to assess the agreement between 99mTcdimercaptosuccinic acid (DMSA) renal scan and Ultrasonography (US) US for evaluating the renal size, renal position, pelvicalyceal dilatation, hydronephrosis and renal scarring in children with recurrent UTI. Study population consisted of 85 children with age range of 6 months to 12 years, who had laboratory evidence of at least two incidence of UTI within 6 months period. All children underwent 99mTc-DMSA renal scan (plannar) and renal tract ultrasonography (US). Among 85 children, 26 (30.6%) had normal DMSA scan and 59 (69.4%) had abnormal DMSA scan findings. In case of US, 23 (27.1%) had normal US findings and 62 (72.9%) had abnormal US findings of renal system. The comparison of DMSA renal scan and US findings were done by Kappa analysis to see their agreement in the evaluation of size, position, pelvicalyceal dilatation and hydronephrosis. This study gave an impression that DMSA scan and US has good agreement in the evaluation of renal size, position of the kidney and fair agreement in the evaluation of presence of hydronephrosis. In case of mild pelvicaliceal dilatation evaluation, DMSA was underestimated comparing to US.The overall accuracy of US for the evaluation of focal scarring of right and left kidney were 89.4% and 78.8% respectively. For the evaluation of diffuse scarring the overall accuracy of US were 92.9% and 97.6% for the right and left kidney respectively. Therefore, in the evaluation of renal scarring the accuracy of US was underestimated by using DMSA scan as a gold standard. In the evaluation of kidney size, position and presence of hydronephrosis, both DMSA and US can be interchangeable. Whereas DMSA was underestimated comparing to US in the evaluation of mild pelvicaliceal dilatation. On the other hand DMSA renal scan is more sensitive and specific for detecting cortical scaring compared to the US. In light of present study, both DMSA scan and US are recommended in the combination for complete evaluation of renal abnormalities in recurrent UTI. Bangladesh J. Nuclear Med. 18(1): 32-38, January 2015

Vesicoureteral Reflux and Renal Scarring Risk in Children after the First Febrile Urinary Tract Infection

Background/Aims: There are many controversies regarding the best approach for evaluating children after their first febrile urinary tract infection (UTI). The aim of this study was to define the clinical, laboratory, and radiological features of patients with their first febrile UTI and to investigate the factors that might predict the presence of vesicoureteral reflux (VUR) and renal scarring. Methods: The files of patients who were followed due to their first febrile UTI between 2008 and 2013 were retrospectively reviewed (n = 300). Patients were divided into groups based on their age, the resistance state of microorganisms, the presence of VUR, and scarring on Tc99m dimercaptosuccinic acid scintigraphy. The chi-square test and Mann-Whitney U test were used for analysis. Results: The median age at the first febrile UTI was 11 months and girls constituted 77% of the patient population. VUR and renal scarring were detected in 30.9 and 19.4% of the patients, respectively. C-reactive protein levels and the presence of renal scarring were significantly higher in patients with VUR (p < 0.05). Abnormal ultrasonography findings, VUR and recurrent UTIs were significantly higher in patients with renal scars (p < 0.001). In multivariate analysis, we did not detect any factor that might predict the presence of VUR and renal scarring. Conclusion: A majority of children had their first febrile UTI at a young age. Although we could not find any factor that might predict the VUR and scar risk in patients with their first febrile UTI, an abnormal renal scan at 6 months after infection was closely related with the presence of VUR and recurrent UTIs.

Results of a universal ultrasonographic hip screening program at a single institution.

The aims of the present study were to determine the prevalence of developmental dysplasia of the hip (DDH) in newborns screened by hip ultrasonography (US), to review outcome of follow-up and treatment of infants with DDH, and to evaluate the relationship between US-based diagnosis and risk factors. A total of 9564 hips of 4782 newborns (2398 females, 50.1%) were evaluated with US. Risk factors for DDH and accompanying deformities were also recorded. Graf classification type IIa(-), IIb, IIc, D, and III hips were treated with Pavlik harnesses. Abnormal US findings (type IIa, IIc, or D hips) were detected in 475 newborns (9.9%). Risk factors and concomitant orthopedic deformities were similar in newborns with and without US abnormality and type I hips (p>0.05 for all). However, abnormal US findings were significantly more common in firstborn and female newborns. A total of 39 hips (5 bilateral, 20 left, 9 right) of 34 newborns (31 females) were placed in Pavlik harnesses. Twelve newborns had type IIc or D hips at initial evaluation, and 22 had type IIb or IIa(-) at follow-up. Mean recovery time was 12.5 (8-16) weeks for newborns with type IIc and D hips, 8.6 (8-12) weeks for those with type IIa(-) hips, and 11.2 (8-12) weeks for those with type IIb hips. DDH is still common among newborns in Turkey. Hip US is recommended for detection and follow-up of DDH in newborns.

Correlation of fine-needle aspiration with fluorodeoxyglucose positron emission tomography and ultrasonography imaging in head and neck lymph nodes

Fluorodeoxyglucose positron emission tomography (FDG-PET) is a well-established tracer technique, particularly useful for oncologic conditions. However, in the head and neck region, this modality may have limitations due to the complex anatomy and high frequency of normal variants in FDG-PET uptake resulting in diagnostic errors. Hence, FDG-PET results often require additional diagnostic investigations including ultrasonography (US), and guided fine-needle aspirations (FNAs) in order to improve diagnosis and patient care. A total of 87 cases of head and neck lymph node FNA were accessioned in the cytopathology laboratory between 2010 and 2013, 75 cases with corresponding standard uptake values (SUVs) were selected to form the current study cohort. Patient demographics, primary tumor site, size of the biopsied lymph node, PET SUV, and US findings, as well as FNA diagnoses and surgical follow-ups were reviewed. SUVs were grouped into 5 ranges: A (2.2-2.9), B (3.0-4.9), C (5.0-6.9), D (7.0-9.9), and E (10.0 +). The SUV cutoff of 5.0 was seen in the groups C, D, and E, which increased the probability of malignancy in the FNA specimens from 67% to 100%. The average size of the lymph nodes was 18.57 mm (range 6-41 mm); it was 13.4, 14.2, 19.7, 18.4, and 20.2 for groups A, B, C, D, and E, respectively. The lymph node measurements represented similarities in groups A and B (13.4, 14.2), and groups C, D, and E (19.7, 18.4, 20.2). Albeit a few exceptions, an increase in the lymph node size 14.2 to 19.7 (ie, from groups A and B to groups C, D, and E) correlated with SUV and US abnormalities. Abnormal US findings were pronounced (100%) in group E, and ranged between 67% and 73% of the cases in other groups. This study documents the usefulness of SUV range in FDG-PET results and not an absolute "cutoff" number for diagnosing suspicious head and neck lymph nodes due to an overlap in the SUVs between malignant and benign lesions. False positive and negative results may occur in hyperplastic and necrotic lymph nodes. An increase in the lymph node size generally compares well with SUVs and US abnormalities; use of US-guided FNAs in these cases can be helpful to achieve definite diagnosis.

Ultrasonography of the lumbar spine: Sonoanatomy and practical applications

Ultrasonography of the bones and joints has gained considerable ground in the field of rheumatology over the past decade and is now used in everyday practice both for diagnostic purposes and to guide local injections. However, the use of ultrasonography is virtually confined to the peripheral joints, whereas spinal diseases make a major contribution to rheumatology practice. Studies have established that ultrasonography of the lumbar spine is feasible. Adequate equipment and familiarity with spinal sonoanatomy are required. In this update, we suggest starting with a systematic examination of the lumbar spine to assess the various anatomic structures, from the thoracolumbar fascia superficially to the posterior part of the vertebras at the deepest level. The ligaments, erector spinae muscles, facet joints, and transverse processes can be visualized. Ultrasonography can serve to guide injections into the facet joints, about the nerve roots, and into the iliolumbar ligaments; as well as to identify relevant landmarks before epidural injection. Although diagnostic applications are more limited at present, systematic studies of abnormal ultrasonography findings will allow evaluations of the potential usefulness of ultrasonography for diagnosing spinal disorders. The depth of the spinal structures limits the ability to obtain high-resolution images. However, future technical improvements in ultrasound transducers and machines, together with the growing number of physicians trained in ultrasonography, can be expected to benefit the development of spinal ultrasonography in the near future.

Związek torbieli splotu naczyniówkowego stwierdzonych w badaniach prenatalnych i ryzyka biochemicznego wystąpienia wad wrodzonych

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Serapinas D, Sukys M, Bardziliauskas P. Associations of prenatally detected choroid plexus cysts with biochemical risk for congenital disorders. Medical Studies/Studia Medyczne. 2014;30(2):71-74. doi:10.5114/ms.2014.43593. APA Serapinas, D., Sukys, M., & Bardziliauskas, P. (2014). Associations of prenatally detected choroid plexus cysts with biochemical risk for congenital disorders. Medical Studies/Studia Medyczne, 30(2), 71-74. https://doi.org/10.5114/ms.2014.43593 Chicago Serapinas, Danielius, Marius Sukys, and Povilas Bardziliauskas. 2014. "Associations of prenatally detected choroid plexus cysts with biochemical risk for congenital disorders". Medical Studies/Studia Medyczne 30 (2): 71-74. doi:10.5114/ms.2014.43593. Harvard Serapinas, D., Sukys, M., and Bardziliauskas, P. (2014). Associations of prenatally detected choroid plexus cysts with biochemical risk for congenital disorders. Medical Studies/Studia Medyczne, 30(2), pp.71-74. https://doi.org/10.5114/ms.2014.43593 MLA Serapinas, Danielius et al. "Associations of prenatally detected choroid plexus cysts with biochemical risk for congenital disorders." Medical Studies/Studia Medyczne, vol. 30, no. 2, 2014, pp. 71-74. doi:10.5114/ms.2014.43593. Vancouver Serapinas D, Sukys M, Bardziliauskas P. Associations of prenatally detected choroid plexus cysts with biochemical risk for congenital disorders. Medical Studies/Studia Medyczne. 2014;30(2):71-74. doi:10.5114/ms.2014.43593.

Place of Ultrasonography in Predicting Vesicoureteral Reflux in Patients With Mild Renal Scarring

To evaluate the role of renal ultrasonography (USG) in predicting vesicoureteral reflux (VUR) in children with mild renal scarring determined by dimercaptosuccinic acid scintigraphy performed after attack of urinary tract infections (UTI). Dimercaptosuccinic acid scintigraphy, voiding cystourethrography (VCUG), and renal USG findings were evaluated retrospectively in children with UTI. Each kidney was evaluated as a separate renal unit (RU). RUs with severe scarring were excluded from the study. RUs having mild scarring with and without abnormal USG findings (group 1 and group 2, respectively) were compared in terms of the presence of VUR. There were a total of 228 patients (70 men, mean age 47.06 ± 44.14 months) and 456 RUs. Of the 185 RUs with mild scarring, 55 had abnormal USG findings (group 1), whereas 130 had normal USG findings (group 2). The rates of VUR and severe VUR (≥grade 4) were higher in group 1 compared with group 2 (69% vs 43%, P = .001 and 35% vs 7% respectively, P <.001). The sensitivity, specificity, positive predictive value, negative predictive value, and odds ratio of USG findings in predicting VUR in RU with mild scarring were 68%, 80%, 38%, 93%, and 8.2, respectively. Normal renal USG findings exclude a diagnosis of high-grade VUR to a large extend in children with UTI and mild renal scarring. Refraining from invasive VCUG might be a reasonable approach in these patients provided that no other predisposing factors for UTI and/or renal scarring present.

The reference intervals of thyroid stimulating hormone in healthy individuals with normal levels of serum free thyroxine and without sonographic pathologies

Introduction: The aim of the present study was to investigate the reference intervals for thyroid stimulating hormone (TSH) in healthy individuals with normal levels of serum free thyroxine (fT4) and without sonographic pathologies, and determine the effects of age, gender, and residence on the TSH reference intervals. Subjects and methods: This research was a population-based study conducted in 70 regions. The random sampling method was used to select the 1095 subjects of the study among inhabitants aged 18 and above. Patients who had a previous history of thyroid disease and had been taking medication were excluded from the study as this may have affected their fT4 or TSH levels. In addition, subjects who had serum fT4 without a reference range and abnormal ultrasonography findings were also excluded. A total of 408 subjects were used for establishing the reference intervals for TSH. Results: The data for TSH in the study group were not normally distributed according to the Kolmogorov–Smirnov index. The geometric mean was 1.62 mIU/L, the median was 1.40 mIU/L, and the 95% reference intervals were 0.38–4.22 mIU/L. The median TSH level was higher in females compared to males (p < 0.05). In the female subjects 2.5th percentile of TSH was lower and 97.5th percentile was higher than those of males. The reference intervals of TSH were of lower values in subjects over 50 years old (p < 0.001). Discussion: Studies suggest that determination of the TSH reference intervals may differ due to environmental influences or due to age, gender, and race. It is suggested that the lower limit of normal TSH for the adult Turkish population would be 0.38 mIU/L and the upper limit similar to the traditional value of 4.2 mIU/L. If each clinician uses their population-specific reference interval for TSH, thyroid function abnormalities can be accurately estimated.

The utility of routine preoperative cervical ultrasonography in patients undergoing thyroidectomy for differentiated thyroid cancer

Preoperative ultrasonography (US) is recommended in all patients with differentiated thyroid cancer (DTC) to evaluate for clinically occult metastatic lymphadenopathy. The purpose of this study was to examine the influence of preoperative US findings on the initial operative management of patients with DTC. This is a retrospective review of 70 patients with biopsy-proven DTC who underwent total thyroidectomy between February 2010 and January 2012. All patients underwent preoperative cervical US (thyroid, central, and lateral neck lymph node compartments). Palpable lateral neck adenopathy was thought to be present in 5 (7%) of the 70 patients, but confirmed by US in only 3; 2 patients avoided lateral compartment neck dissection (LCND). Of 65 patients with no palpable lymphadenopathy, 14 (22%) had abnormal lymphadenopathy on preoperative US. All 14 patients underwent total thyroidectomy with central compartment neck dissection (CCND); 12 patients with abnormal US findings in the lateral compartment(s) also underwent LCND. Metastatic disease was confirmed in 13 (93%) of the 14 patients: 13 of 14 who underwent CCND and 11 (92%) of 12 who underwent LCND. This study confirms the importance of preoperative, high-quality cervical US in patients with DTC because it changed the operative management in 16 of 70 patients (23%); 13 had a more complete operation for pathologically confirmed, clinically occult, lymph node metastases, 2 avoided nontherapeutic LCND, and 1 had false-positive US results.

Early Primary Cytomegalovirus Infection in Pregnancy: Maternal Hyperimmunoglobulin Therapy Improves Outcomes Among Infants at 1 Year of Age

Primary cytomegalovirus (CMV) infection during pregnancy is the leading infectious cause of congenital neurological disabilities. Early CMV infection carries a higher risk of adverse neonatal outcome (sensorineural hearing loss or neurological deficits). Intravenous hyperimmunoglobulin (HIG) therapy seems to be promising, but its efficacy needs further investigation. Since 2002, we have enrolled consecutively all pregnant women with early (ie, before gestational week 17) CMV infection. Beginning in 2007, all women were offered treatment with HIG (200 UI per kilogram of maternal weight, in a single intravenous administration). Outcome of infants was evaluated at the age of 1 year. Of the 592 women with early primary CMV infection, amniocentesis for CMV DNA detection was performed for 446. Of the 92 CMV-positive fetuses, pregnancy was terminated for 24, HIG was administered to mothers of 31, and no treatment was received by mothers of 37. Fetuses of treated mothers did not differ from fetuses of nontreated mothers according to mother's age, gestational week of infection, CMV load, or detection of abnormal ultrasonography findings. At the 1-year evaluation, 4 of 31 infants with treated mothers (13%; 95% confidence interval [CI], 1%-25%) and 16 of 37 infants with nontreated mothers (43%; 95% CI, 27%-59%) presented with poor outcomes (P < .01, by the 2-tailed Fisher exact test). HIG treatment improved the outcome of fetuses from women who had primary CMV infection before gestational week 17.

Magnetic resonance imaging versus ultrasound at early post-term age in brain imaging of preterm infants

Objective: To compare the incidence of brain lesions detected on cranial ultrasonography (US) and magnetic resonance imaging (MRI) at early post-term age in a group of preterm infants. Subjects and methods: In this prospective study, entry criteria were very preterm infants with birth weight ≤1250 g or gestational age ≤30 weeks, or brain lesions on early US scan. 73 neonates were included in the study. All infants underwent sequential cranial US scans and an US and MRI scan at early post-term age. Results: Abnormal US and MR findings were detected in 53.4% and 84.9% of neonates respectively. US underestimated the diffuse white matter damage shown in 6.9% and on MRI in 26.4% of neonates, the increase of the subarachnoid space shown on US in 19.2% and on MRI in 43.1% of neonates and thinning of the corpus callosum detected on US in only 5.5% and on MRI in 27.4% of neonates. MRI was the only method to detect abnormalities in the posterior fossa, basal ganglia, cortex and the posterior limb of the internal capsule. US detected with high sensitivity the presence of cystic periventricular leukomalacia, ventricular enlargement, persistent germinal matrix/intraventricular hemorrhage and porencephalic cyst as a result of periventricular hemorrhagic infraction. Conclusion: MRI offers more complete visualization of brain lesions in preterm neonates and is more informative in regard to diagnosis. Follow up assessment of these neonates is needed to show the relationship to neurodevelopment outcome.