Changes In Echogenicity Research Articles

HEPATIC MANIFESTATIONS OF INFECTIOUS DISEASES. PRESENTATION OF CLINICAL CASE

There are infectious diseases that produce alterations in liver function tests and histology, through the activation, by endotoxins and other agents of the innate immunity pathway. This work aims to review the hepatic manifestations of diseases such as dengue and brucellosis in the pediatric age by means of clinical cases. Case 1: 17-year-old male with a history of travel to an endemic area and family members positive for dengue. Fever, myalgias, arthralgias, arthralgias and headache. On admission with leukocytes 6.93 thousand, platelets 189 thousand and positive IgG and IgM antibodies for dengue fever. Physical examination with hepatodynia and petechiae in the pelvic limbs. In control biochemistry with leukopenia and moderate thrombocytopenia, as well as alterations in liver function (Table 1). Ultrasound of the liver with data of acute inflammatory process. Seven days after admission, with clinical and biochemical improvement, it was decided the discharge of the patient. Caso 2: male, four years nine months old, with symptoms of 1 month of evolution characterized by fever, hyporexia and general malaise. Physical examination with icteric-pale color, hepatomegaly of 3 × 5 × 7 cm and splenomegaly of 4 cm. Paraclinical tests showed anemia, leukopenia and mild-moderate thrombocytopenia, hypertransaminasemia, cholestasis and TTP prolongation (Table 2) with positive rose bengal, hepatic USG with hepatomegaly and echogenicity changes, for which he was sent to the third level of care. The mechanisms of liver injury can be divided into four pathways: vascular, toxic, immune and hormonal. In infections, the immune pathway is the cause of liver damage, being activated by endotoxins, leading to inflammatory infiltration, the release of cytokines, reactive oxygen species and necrosis. In dengue infection, liver injury manifests with hypertransaminasemia, with a peak between the seventh and ninth day, progressive decrease and normalization between 2 to 8 weeks. Hepatic involvement in brucellosis can occur in the acute or chronic phase of the disease. In the acute phase, establishing a non-specific granulomatous hepatitis, increasing in 63% of the cases the liver function tests. The functions of the liver and the relationships it establishes with other organs may favor its injury during some infectious pathologies, being at this level one of the first manifestations in the context of an infectious disease, ruling out, in both cases, liver pathology by hepatotropic virus, metabolic, autoimmune and anatomical cause. The authors declare that there is no conflict of interest.

Evaluation of race performance after tendon injuries in race horses with special respect to lesion related parameters

The study aimed to assess the race performance after injury of the palmar metacarpal tendon region in Thoroughbred and Arabian racehorses. A special scoring system was established to evaluate the performance of the horses for each race after the injury, objectively in this study. Thus, individual total race earnings, the rates of ranking among the top four in at least two and three races and the number of participated races after injury were also analysed. The performance scores after injury were found to be lower in tendinitis cases compared to peritendinitis cases (P=0.0004). It was found that the success rate was lower in cases with tendon lesions than in cases without lesions in terms of race performance after injury (P=0.006). Injuries causing tendon thickening and also tendon echogenicity alterations had negative effects on race performances after injury (P=0.01 and P=0.04, respectively). Also individual total race earnings were lower in cases with tendon thickening compared to those without thickening (P=0.02). According to the results of this study, it is recommended to take prophylactic measures for tendinitis in cases with tendon thickening and echogenicity changes detected by ultrasound in the early stages of tendinitis to be able to display a good race performance after injury.

Natural History of Asymptomatic Esophageal Subepithelial Tumors of 30 mm or Less in Size.

BackgroundNo definite guidelines for the management of small esophageal subepithelial tumors (SETs) have been established, because there are limited data and studies on their natural history. We aimed to assess the natural history and propose optimal management strategies for small esophageal SETs.MethodsPatients diagnosed as esophageal SETs ≤ 30 mm in size between 2003 and 2017 using endoscopic ultrasound (EUS) with a minimal follow-up of 3 months were enrolled, and their esophagogastroduodenoscopy (EGD) and EUS were retrospectively reviewed.ResultsOf 275 esophageal SETs in 262 patients, the initial size was < 10 mm, 10–20 mm, and 20–30 mm in 104 (37.8%), 105 (38.2%), and 66 (24.0%) lesions, respectively. Only 22 (8.0%) SETs showed significant changes in size and/or echogenicity and/or morphology at a median of 40 months (range, 4–120 months). Tissues of 6 SETs showing interval changes were obtained using EUS-guided fine needle aspiration biopsy; 1 was identified as a gastrointestinal stromal tumor (GIST) and was surgically resected, while the other 5 were leiomyomas and were regularly observed. Eight SETs showing interval changes were resected surgically or endoscopically without pathological confirmation; 1 was a GIST, 2 were granular cell tumors, and the other 5 were leiomyomas.ConclusionRegular follow-up with EGD or EUS may be necessary for esophageal SETs ≤ 30 mm in size considering that small portion of them has a possibility of malignant potential. When esophageal SETs ≤ 30 mm show significant interval changes, pathological confirmation may precede treatment to avoid unnecessary resection.

ULTRASOUND IMAGING OF THE SPLEEN, STOMACH, LIVER, KIDNEYS, BLADDER, AND PROSTATE IN PIGLETS (Sus scrofa domestica)

This study aims to describe ultrasonographic imaging of the spleen, stomach, liver, kidney, bladder, and prostate in piglets (Sus scrofa domestica). Ultrasonography was performed on six male piglets aged 1 month with a body weight of 4-8 kg. Ultrasonography of the spleen, stomach, liver, urinary bladder, and prostate was observed in the dorsal-recumbency position, and the kidney was observed in the lateral-recumbency position. The ultrasound examination used the Chison EBit 60, which is a linear type transducer with a frequency of 9 MHz, transverse and sagittal positions, and a gain of about 55-80. Ultrasonography of the spleen showed that the shape of the spleen head varied in each individual. The results of gastric ultrasonography showed the gastric lining clearly and the similarity of the position, shape, structure, echogenicity, and size of the stomach. The results of liver ultrasonography showed that the echogenicity of the liver tended to be hyperechoic, the kidneys were hyperechoic, and the bladder was hypoechoic due to the use of improper gain. The average length of the right kidney was 4.73±0.50 cm and the left kidney was 4.08±0.26 cm. The bladder wall thickness was 1.3±0.31 mm. Imaging of the bladder showed changes in wall size and echogenicity. Prostate ultrasound results obtained an average length of 2.68±0.45 cm, width 1.69±0.35 cm. The results of this study can be used as a reference for normal data on organ position, organ structure, and organ echogenicity of the spleen, stomach, liver, kidney, bladder, and prostate in piglets.

Intravascular Ultrasound Can Be Used to Locate Nerves, but not Confirm Ablation, During Renal Sympathetic Denervation.

BackgroundNo methods exist for confirming nerve ablation in catheter-based renal sympathetic denervation (RDN).MethodsWe investigated the feasibility of using intravascular ultrasound (IVUS) to locate nerves and observe nerve integrity changes during RDN in a pig. To confirm our observations, we used post-RDN histological sections matched anatomically to the IVUS images.ResultsIVUS revealed multiple hypoechoic structures along the renal artery, whose locations matched those of nerves in the histological sections. Nerves clustered near the junction between the renal artery and vein. Histology confirmed necrosis of nerve bundles at RDN ablation sites, but no changes in echogenicity were observed using IVUS.ConclusionsAlthough IVUS cannot currently be used to confirm ablation during RDN, it clearly reveals some clusters of renal sympathetic nerves. It remains to be demonstrated how IVUS can guide RDN devices and potentially improve ablation success.

Ultrasound Echogenicity-based Assessment of Muscle Fatigue During Functional Electrical Stimulation.

The rapid onset of muscle fatigue during functional electrical stimulation (FES) is a major challenge when attempting to perform long-term periodic tasks such as walking. Surface electromyography (sEMG) is frequently used to detect muscle fatigue for both volitional and FES-evoked muscle contraction. However, sEMG contamination from both FES stimulation artifacts and residual M-wave signals requires sophisticated processing to get clean signals and evaluate the muscle fatigue level. The objective of this paper is to investigate the feasibility of computationally efficient ultrasound (US) echogenicity as a candidate indicator of FES-induced muscle fatigue. We conducted isometric and dynamic ankle dorsiflexion experiments with electrically stimulated tibialis anterior (TA) muscle on three human participants. During a fatigue protocol, we synchronously recorded isometric dorsiflexion force, dynamic dorsiflexion angle, US images, and stimulation intensity. The temporal US echogenicity from US images was calculated based on a gray-scaled analysis to assess the decrease in dorsiflexion force or motion range due to FES-induced TA muscle fatigue. The results showed a monotonic reduction in US echogenicity change along with the fatigue progression for both isometric (R2 =0.870±0.026) and dynamic (R2 =0.803±0.048) ankle dorsiflexion. These results implied a strong linear relationship between US echogenicity and TA muscle fatigue level. The findings indicate that US echogenicity may be a promising computationally efficient indicator for assessing FES-induced muscle fatigue and may aid in the design of muscle-in-the-loop FES controllers that consider the onset of muscle fatigue.

Cavitation dynamics of histotripsy bubble cloud nucleated from echogenic liposomes

Deep vein thrombosis is a serious health concern worldwide. Administration of catheter-directed thrombolytics is the primary approach to achieve vessel patency for critical obstructions. Adjuvant techniques that localize thrombolytic delivery will improve treatment outcomes and reduce the potential caustic bleeding associated with systemic lytic administration. Histotripsy is a bubble-based focused ultrasound therapy that has been shown to act synergistically with lytic to promote clot degradation. Combining histotripsy with a targeted drug delivery agent may further improve treatment efficacy. Echogenic liposomes are vesicles formulated to entrain the thrombolytic, and can be triggered with ultrasound to release drugs locally. The objective of this study was to assess histotripsy bubble cloud dynamics nucleated from echogenic liposomes in an in vitro venous flow model. The change in liposome echogenicity following histotripsy exposure was assessed with high frame rate imaging. Hypoechogenicity indicative of liposome destruction extended beyond the focal region, with a strong decrease in pixel intensity immediately after the applied histotripsy pulse. Interestingly, echogenicity was restored to baseline levels over the course of ∼4 s, which was attributed to vigorous fluid mixing from bubble cloud oscillations. These results indicate an interesting range of bubble cloud behaviors when histotripsy is combined with echogenic liposomes.

Respiratory and peripheral muscular ultrasound characteristics in ICU COVID 19 ARDS patients.

PurposeSevere cases of coronavirus disease 2019 develop ARDS requiring admission to the ICU. This study aimed to investigate the ultrasound characteristics of respiratory and peripheral muscles of patients affected by COVID19 who require mechanical ventilation.Materials and methodsThis is a prospective observational study. We performed muscle ultrasound at the admission of ICU in 32 intubated patients with ARDS COVID19. The ultrasound was comprehensive of thickness and echogenicity of both parasternal intercostal and diaphragm muscles, and cross-sectional area and echogenicity of the rectus femoris.ResultsPatients who survived showed a significantly lower echogenicity score as compared with those who did not survive for both parasternal intercostal muscles. Similarly, the diaphragmatic echogenicity was significantly different between alive or dead patients. There was a significant correlation between right parasternal intercostal or diaphragm echogenicity and the cumulative fluid balance and urine protein output. Similar results were detected for rectus femoris echogenicity.ConclusionsThe early changes detected by echogenicity ultrasound suggest a potential benefit of proactive early therapies designed to preserve respiratory and peripheral muscle architecture to reduce days on MV, although what constitutes a clinically significant change in muscle echogenicity remains unknown.

Частота функциональных расстройств билиарного тракта у детей с атопическим дерматитом

Актуальность. Как отмечают многие авторы, тяжесть течения и выраженность атопического дерматита (АД) во многом зависят от функционального состояния органов пищеварения. Цель: исследовать частоту и проанализировать особенности течения атопического дерматита у детей с нарушениями билиарной системы. Материалы и методы. Обследовано 168 детей в возрасте от 1 до 18 лет с АД. Диагноз АД у детей выставляли согласно диагностическим критериям J.M. Hanifin и G. Rajka (1980). Все пациенты и их родители были анкетированы с использованием карты обследования. Изучали общий и специфические IgE (педиатрическая панель). Состояние билиарной системы изучали с помощью ультрасонографии, биохимических показателей сыворотки крови. Статистическая обработка результатов исследований осуществлялась с помощью стандартных алгоритмов вариационной статистики. Результаты. По данным анкетирования выявлены следующие факторы риска развития АД у детей и подростков: наследственность (53,5 %), проявления аллергии на первом году жизни (62,5 %), высокие уровни IgЕ (52,3 %); факторы, способствующие обострению АД (триггеры): смешанные аллергены — 23,8 %, пищевые аллергены — 71,4 %, лекарственные аллергены — 17,8 %, бытовые аллергены — 5,9 %, пыльцевые аллергены — 3,4 %, температурный фактор — 1,7 %, психоэмоциональный фактор — 1,7 %, неустановленные — 24,6 %; искусственное вскармливание с рождения (13,1 %); общая продолжительность манифестации АД: до года — 11,3 %, от 1 до 5 лет — 44,9 %, от 5 до 10 лет — 23,8 %, более 10 лет — 20,3 %. Среднее значение по шкале SCORAD у пациентов с легкой степенью АД составило 14,01 ± 0,63 балла, со средней степенью АД — 31,04 ± 0,92 балла, у пациентов с тяжелой степенью — 56,17 ± 5,23 балла. Средний балл по шкале EASI у обследованных пациентов в возрасте от 5 до 7 лет составил 8,67 ± 0,46. Повышенный уровень IgE отмечался у 52,3 % детей. При активном опросе и осмотре признаки функционального расстройства билиарного тракта обнаружены у большинства пациентов — 109 (64,8 ± 3,2 %) детей. При УЗИ у 45 (42,8 %) из 109 детей, которые имели жалобы, установлена дисфункция желчного пузыря. Увеличение размеров печени (до 10 %) без изменения эхоструктуры и эхогенность наблюдалось у 26 (23,8 ± 0,8 %) детей с АД. Выводы. С учетом высокой частоты функциональных нарушений билиарного тракта детям с АД целесообразно проводить ультразвуковое исследование органов пищеварительной системы. На основе полученных данных важно проводить соответствующую коррекцию выявленных нарушений в комплексном лечении АД.

Клініко-сонографічні особливості стеатозу підшлункової залози у дітей з надмірною вагою та ожирінням

Актуальність. Своєчасна діагностика стеатозу підшлункової залози (ПЗ) є необхідною умовою виявлення раннього метаболічного ризику та зниження захворюваності на хронічну гастроентерологічну патологію. Мета. Вивчення клініко-інструментальних особливостей стеатозу ПЗ у дітей із надмірною вагою та ожирінням. Матеріали та методи. У 53 дітей із функціональними розладами шлунково-кишкового тракту визначали наявність стеатозу ПЗ за допомогою ультразвукового дослідження. Розподіл за групами відбувся на основі наявності стеатозу ПЗ, ожиріння та надмірної ваги: 1 групу становили 24 пацієнти зі стеатозом ПЗ, ожирінням та надмірною вагою, 2 групу — 18 дітей з ожирінням і надмірною вагою без ознак стеатозу ПЗ, контрольну групу — 11 пацієнтів без стеатозу ПЗ, які мали нормальну вагу. Результати. Клінічна картина у дітей зі стеатозом ПЗ у більшості пацієнтів пояснювалась наявністю супутньої гастроентерологічної патології; 29,1 % хворих основної групи скаржились на біль у лівому підребер’ї. При аналізі диспептичних скарг слід відзначити, що пацієнти зі стеатозом ПЗ частіше скаржились на нудоту (58,3 %), метеоризм (45,8 %) проти пацієнтів, які мали нормальну вагу, однак значущість відмінностей не була достатньою. У пацієнтів 1 групи частіше виявлялась болісність при пальпації за ходом кишечника проти пацієнтів 2 групи. Болісність при пальпації в панкреатичних точках була вірогідно вищою у пацієнтів 1 групи (54,1 %) проти 3 групи. Підвищення ехогенності печінки в 2,4 раза частіше зустрічалось у пацієнтів 1 групи проти 2 групи та в 7 раз частіше, ніж у 3 групі. Зокрема, зміни зернистості печінки втричі частіше зустрічались у пацієнтів зі стеатозом ПЗ (p &lt; 0,05), ніж у пацієнтів без стеатозу та з трофічними розладами, а також дітей, які мають нормальну вагу. Зміни ПЗ при її стеатозі проявлялись не лише змінами ехогенності, але й у майже половини пацієнтів (45,8 %) наявністю нечітких контурів органу, підвищенням зернистості (65,5 %). Об’єм і товщина стінки жовчного міхура були вірогідно вищими у групі дітей зі стеатозом ПЗ проти контрольної групи. Ознаки біліарного сладжу вдвічі частіше зустрічались у дітей зі стеатозом проти групи дітей без стеатозу та в 4 рази частіше, ніж у дітей, які мають нормальну вагу (43,87 % у 1 групі, 21 % у 2 групі та 9 % у 3 групі). Висновки. Клінічні та сонологічні зміни у пацієнтів зі стеатозом ПЗ свідчать про можливість запальних змін у паренхімі залози, що пов’язані із системним запаленням на фоні стеатозу та супутньою патологією органів шлунково-кишкового тракту.

Ultrasonography Findings in the Proximal Sciatic Nerve and Deep Gluteal Muscles in 29 Dogs With Suspected Sciatic Neuritis.

The present study aimed to describe the ultrasonography technique and analyze the ultrasonographic findings of the proximal sciatic nerve and deep gluteal muscles in dogs with suspected sciatic neuritis. The records of 29 dogs that underwent musculoskeletal ultrasound of the sciatic nerve and deep gluteal muscles were retrospectively evaluated. Both right and left sides were evaluated. Abnormal findings were unilateral in 28/29 (97%) of the dogs. The muscles examined included the piriformis muscle, gemelli muscles, internal obturator muscle, and medial gluteal muscle. Data included signalment, purpose of the dog, orthopedic examination findings, lameness examination findings, other diagnostic imaging findings, and ultrasonography findings. Irregular margins of the sciatic nerve were recorded in 76% of the dogs. The diameter of the sciatic nerve on the affected limb was significantly larger than the nerve on the contralateral, unaffected side (p < 0.00001). The mean ± standard deviation (SD) of the sciatic nerve inner diameter between the unaffected and affected limbs was 15 ± 14.66%. The mean ± SD in sciatic nerve outer diameter was 12 ± 7.71%. Abnormal ultrasonographic findings in at least one of the examined muscles were found in 28/29 (97%) of the dogs and included changes in echogenicity in 28/29 (97%) of the dogs, loss of detail in muscle fiber pattern in 5/29 (17%) of the dogs, and impingement between the sciatic nerve and piriformis muscle in 6/29 (21%) of the dogs. The most common underlying diagnosis was lumbosacral stenosis in 9/29 (31%) of the dogs. The most common sport was agility for 21/29 (71%) of the dogs. Repetitive jumping may predispose to both lumbosacral disease, through dynamic compression, and changes within the piriformis muscle, due to overuse of the muscle leading to irritation to sciatic nerve. Ultrasonography is considered a safe and non-invasive diagnostic method to evaluate the sciatic nerve and deep gluteal muscles of dogs, and provides additional guidance for diagnostics and rehabilitation planning. This is the first study documenting ultrasonography findings in a case series of the sciatic nerve and deep gluteal muscles and their pathology in dogs.

Ultrasonography-guided sialolithotomy and stricture dilations of the major salivary glands: a preliminary study.

Aim of the study: The present preliminary study aims to evaluate the possible positive outcomes of ultrasonography-guided sialolithotomies and duct stricture dilations utilizing stone retrieval baskets and guide wires. Case description: A total of 6 cases in an ongoing study (4 cases of sialolithiasis and 2 cases of duct strictures with intraluminal adhesion) were analyzed. All sialoliths were <5 mm in diameter. Stone removals and duct dilations were performed under ultrasonography guidance with two different types of linear probes. Edema measurements were carried out, and the area of edema was evaluated via the echogenicity changes. Patient satisfaction was also evaluated by the patients themselves using a Visual Analog Scale questionnaire on postoperative day 0, and on days 1, 2, and 3. Conclusions: There were no postoperative complications, and mouth openings returned to normal at 7-day follow-up. The pain scores decreased after 6 hours, and pain subsided completely after 12 hours in all the patients. Edema also resolved gradually after the operation. The patient satisfaction levels were high.

Ultrasonography-guided sialolithotomy and stricture dilations of the major salivary glands: a preliminary study

Aim of the study: The present preliminary study aims to evaluate the possible positive outcomes of ultrasonography-guided sialolithotomies and duct stricture dilations utilizing stone retrieval baskets and guide wires. Case description: A total of 6 cases in an ongoing study (4 cases of sialolithiasis and 2 cases of duct strictures with intraluminal adhesion) were analyzed. All sialoliths were &lt;5 mm in diameter. Stone removals and duct dilations were performed under ultrasonography guidance with two different types of linear probes. Edema measurements were carried out, and the area of edema was evaluated via the echogenicity changes. Patient satisfaction was also evaluated by the patients themselves using a Visual Analog Scale questionnaire on postoperative day 0, and on days 1, 2, and 3. Conclusions: There were no postoperative complications, and mouth openings returned to normal at 7-day follow-up. The pain scores decreased after 6 hours, and pain subsided completely after 12 hours in all the patients. Edema also resolved gradually after the operation. The patient satisfaction levels were high.

Comparison Between Ultrasonographic and Standing Magnetic Resonance Imaging Findings in the Podotrochlear Apparatus of Horses With Foot Pain.

This prospective study aimed to blindly compare the ultrasonographic and standing magnetic resonance imaging (sMRI) findings in deep digital flexor tendon (DDFT), navicular bone, and navicular bursa in horses with foot pain, positive digital analgesia, and without definitive radiographic diagnosis. Ultrasonography detected more DDFT abnormalities (32/34 feet vs. 27/34 with sMRI) but identified less palmar navicular abnormalities (23/34 feet vs. 30/34 with sMRI). In suprasesamoidean DDFT lesions, which were mainly dorsally located, changes in echogenicity did not correspond to a particular pattern of sMRI signal change. Transcuneal ultrasonography did not allow assessment of morphology and extent of distal DDFT lesions, and sporadically discriminated the affected lobe compared to sMRI. Defects of the palmar compact bone were identified with both modalities except a parasagittal defect, which was only seen at sMRI.

Sonographic Assessment of the Normal and Abnormal Feline Mammary Glands and Axillary and Inguinal Lymph Nodes.

Ultrasound has been used as a diagnostic tool in normal mammary glands and mammary tumors of several species. This study aims to describe the B-mode and Doppler ultrasound features of the mammary glands and draining lymph nodes in 32 adult female cats. Group 1 (G1) consisted of 22 cats without changes in the mammary glands. The average age was 45 ± 25.09 months, where 63.6% (n = 14) were neutered and 31.8% (n = 7) had received progestin at some point for reproductive control. Mammary gland structure was predominantly hypoechoic and homogeneous, with well-defined margins. The average thickness was 1.52 ± 1.59 mm, although it may be affected by estrus, pregnancy, and lactation. In G1, 100% of lymph nodes were homogeneous, 98% were hypoechoic, and 100% were with well-defined margins and hilar vascularization. Group 2 (G2) consisted of 10 cats with mammary nodules. The average age was 88.8 ± 40.5 months, and 70% were intact and all had already received progestin. Ultrasound demonstrated enlarged mammary glands, with nodules of different textures clinically, mainly affecting the abdominal mammary glands (61%). In 33.33%, there were visible mammary ducts. Only 54.17% were homogeneous, 95.83% were hypoechoic, and the margins were regular in 52.08%. Lymph nodes in abnormal mammary chains may present changes in size, shape, echotexture, and echogenicity. Ultrasound examination of the mammary glands and lymph nodes are possible to evaluate the entire mammary chain as well the superficial inguinal and axillary lymph nodes for abnormalities in the feline.

Adolescent Pitcher Fatigue: Ulnar Collateral Ligament Stress, Flexor-Pronator Mass Energy Depletion, and Correlation to Pitch Count

Objectives:There has been a rise in elbow ulnar collateral ligament (UCL) injuries in youth pitchers over recent years. With forearm flexor-pronator mass fatigue, the dynamic stability provided could be diminished placing greater stress on the UCL. Pitch count limits have been instituted in an attempt to help curtail this rise in throwing injuries, especially in youth athletes. In order to provide more objective data regarding current pitch count limits for youth pitchers, the purpose of this pilot study was to evaluate for potential fatigue of the flexor-pronator mass by assessing changes in medial elbow laxity, noninvasively characterizing changes in muscle glycogen storage within the forearm flexor-pronator mass, and evaluating changes in subjective fatigue, strength, range of motion (ROM), pitching velocity, and accuracy with increasing number of pitches thrown by 10-year-old pitchers up to their recommended 75 pitch count limit.Methods:After appropriate power analysis, male pitchers 10 years of age were recruited for the study (n=22). Pitchers threw a total of 75 pitches divided into sets of 25 pitches, with standardized periods of rest in between throws and sets to best simulate a game. Bilateral medial elbow laxity was measured by applying 10 decanewtons of valgus force with a standardized stress device and utilizing ultrasound imaging (Figures 1A-B) prior to pitching and after each pitching set. The change in medial ulnohumeral joint distance (Figure 1C) after stress was applied was calculated from baseline without stress. Relative changes in muscle glycogen storage, detected as changes in echogenicity, within the flexor carpi radialis (FCR) and the flexor digitorum superficialis (FDS)/flexor carpi ulnaris (FCU) muscles were measured non-invasively with ultrasound-based software (Figures 1D-E) and recorded as fuel percentile. Repeated measures analysis of variance and post-hoc testing were used to determine statistical significance (alpha=0.05).Results:There were no significant differences in medial elbow laxity between arms or time points. There was a trend for similar decline in FCR fuel percentile values between each arm, indicating relative decreases in glycogen storage bilaterally. However, only the throwing arm demonstrated a statistically significant decline in fuel percentile from baseline to after 75 pitches (p=0.05). There were no statistically significant differences across time points for FDS/FCU fuel percentile values. Fatigue measurements for both arms were significantly higher at all time points compared to baseline (p≤0.03). Grip strength of the dominant arm after 75 pitches was significantly decreased compared to after 25 pitches (p=0.02). There were no statistically significant changes in other strength measurements, ROM, velocity, or accuracy between all time points.Conclusions:By the recommended 75 pitch count limit in 10-year-olds, subjective fatigue and a decrease in grip strength had occurred. Furthermore, relative glycogen storage of the flexor-pronator mass of the throwing arm decreased between pitching 50 to 75 pitches, but without an increase in medial elbow gapping. This study provides a foundation and raises questions for further objective testing of physiologic changes that occur throughout increasing pitching to better guide pitch count limits and ensure the safety of young athletes

CME Sonography 99/Answers: Kidney Echo Changes

CME Sonography 99/Answers: Kidney Echo Changes Abstract. Normal kidneys have a smooth contour, kidney length 9-12 cm, volume 90-180 ml/1.73 m2 body surface, parenchyma width 13-18 mm and an echogenicity of the cortex which is hypoechoic compared to the liver and spleen, as well as medullary pyramids, which are again hypoechoic compared to the cortex. Digital ultrasound images enable the echogenicity to be measured between 0 (black) and 255 (white). A normal quotient between the echogenicity of the liver and the renal cortex is 1.0-1.4. A normal quotient between the spleen and the renal cortex is> 1.0. The normal quotient between the renal cortex and the renal medulla is> 1.0. In diffuse renal parenchyma diseases, changes in echogenicity are observed. There are kidneys with increased echogenicity of the cortex and a ratio to liver and spleen of <1.0 and kidneys with hyperechoic renal medulla and the ratio between renal cortex and renal medulla <1.0.

Staging of Plantar Fasciitis According to Ultrasonography

Objective. Analysis of sonographic examination of plantar aponeurosis in norm and in plantar fasciitis, determination of the staging of plantar fasciitis depending on the duration of the pain syndrome and sonographic changes in plantar aponeurosis.&#x0D; Materials and Methods. 193 patients (272 cases) with plantar fasciitis (131 females and 62 males). The average age of patients was 47.69±0.97 years (18-81 years). Unilateral pathology was noted in 114 patients (114 cases) and bilateral – in 79 patients (158 cases). The average body mass index was 26.68±0.24. The average duration of pain syndrome was 101.12±5.83 days (7-390 days). The pain syndrome lasted up to 1 month in 26 patients (37 cases), from 1 to 6 months – in 126 patients (181 cases), and more than 6 months – in 41 patients (54 cases). The control group included 20 healthy volunteers (40 feet). Clinical radiological, sonographic, and statistical methods were used.&#x0D; Results. The average thickness of plantar aponeurosis in the study group was 6.14±1.49 mm (2.3-7.7 mm) and in control group – 3.5±0.1 mm (2.5-4.4 mm). There were three stages of the plantar fasciitis. Stage I was characterized by the absence of thickening of the plantar aponeurosis and structural changes, and by signs of local perifocal edema in the subcutaneous fat of the area adjacent to the aponeurosis, which are manifested by a zone of heterogeneous echogenicity. Stage II was characterized by a spindle-shaped form of aponeurosis, a thickening of enthesis more than 4 mm, significant reduction in echogenicity, erased or missing fibrous pattern, fuzzy contour of the aponeurosis, and modified contour of the calcaneus. At stage III, inequality of the cortical calcaneal contour and small focal hyperechogenicity points in enthesis were detected. Distal free part of the aponeurosis also changed. Loci of vascularization were detected using power Doppler sonography.&#x0D; Conclusions. A quantitative sonographic sign of plantar fasciitis is the thickening of the enthesis of the plantar aponeurosis of more than 4 mm. Qualitative signs were changes in echogenicity and structure, changes in the contours of the cortical layer of enthesis and plantar aponeurosis, and distribution of echographic changes distally to the free part of the aponeurosis. The described signs, when compared with the duration of the pain syndrome, determine the stage of plantar fasciitis.

CME Sonography 99: Kidney Echo Changes

CME Sonography 99: Kidney Echo Changes Abstract. Normal kidneys have a smooth contour, kidney length 9-12 cm, volume 90-180 ml/1.73 m2 body surface, parenchyma width 13-18 mm and an echogenicity of the cortex which is hypoechoic compared to the liver and spleen, as well as medullary pyramids, which are again hypoechoic compared to the cortex. Digital ultrasound images enable the echogenicity to be measured between 0 (black) and 255 (white). A normal quotient between the echogenicity of the liver and the renal cortex is 1.0-1.4. A normal quotient between the spleen and the renal cortex is >1.0. The normal quotient between the renal cortex and the renal medulla is >1.0. In diffuse renal parenchyma diseases, changes in echogenicity are observed. There are kidneys with increased echogenicity of the cortex and a ratio to liver and spleen of <1.0 and kidneys with hyperechoic renal medulla and the ratio between renal cortex and renal medulla <1.0.

Skeletal Muscle Changes, Function, and Health-Related Quality of Life in Survivors of Pediatric Critical Illness

To describe functional and skeletal muscle changes observed during pediatric critical illness and recovery and their association with health-related quality of life. Prospective cohort study. Single multidisciplinary PICU. Children with greater than or equal to 1 organ dysfunction, expected PICU stay greater than or equal to 48 hours, expected survival to discharge, and without progressive neuromuscular disease or malignancies were followed from admission to approximately 6.7 months postdischarge. None. Functional status was measured using the Functional Status Scale score and Pediatric Evaluation of Disability Inventory-Computer Adaptive Test. Patient and parental health-related quality of life were measured using the Pediatric Quality of Life Inventory and Short Form-36 questionnaires, respectively. Quadriceps muscle size, echogenicity, and fat thickness were measured using ultrasonography during PICU stay, at hospital discharge, and follow-up. Factors affecting change in muscle were explored. Associations between functional, muscle, and health-related quality of life changes were compared using regression analysis. Seventy-three survivors were recruited, of which 44 completed follow-ups. Functional impairment persisted in four of 44 (9.1%) at 6.7 months (interquartile range, 6-7.7 mo) after discharge. Muscle size decreased during PICU stay and was associated with inadequate energy intake (adjusted β, 0.15; 95% CI, 0.02-0.28; p = 0.030). No change in echogenicity or fat thickness was observed. Muscle growth postdischarge correlated with mobility function scores (adjusted β, 0.05; 95% CI, 0.01-0.09; p = 0.046). Improvements in mobility scores were associated with improved physical health-related quality of life at follow-up (adjusted β, 1.02; 95% CI, 0.23-1.81; p = 0.013). Child physical health-related quality of life at hospital discharge was associated with parental physical health-related quality of life (adjusted β, 0.09; 95% CI, 0.01-0.17; p = 0.027). Muscle decreased in critically ill children, which was associated with energy inadequacy and impaired muscle growth postdischarge. Muscle changes correlated with change in mobility, which was associated with child health-related quality of life. Mobility, child health-related quality of life, and parental health-related quality of life appeared to be interlinked.