Echographic Changes Research Articles

Clinical Evolution of Autoimmune Thyroiditis in Children and Adolescents

Few studies have addressed the clinical evolution of autoimmune thyroiditis (AIT) occurring in childhood and scant data are available on the role of thyroid ultrasonography. We aimed to evaluate the natural history of AIT diagnosed in children and adolescents and to assess the possible prognostic role of ultrasonography. Retrospective case series prospectively followed up for a further 3-year period. A series of 23 patients with AIT, diagnosed before 18 years of age from 1994 to 2004, was further followed up from 2005 to 2007 with clinical, laboratory, and ultrasound evaluation. Hypothyroid patients were treated with levothyroxine (LT(4)), while euthyroid patients were left untreated. Patients with subclinical hypothyroidism were also evaluated 40 days after LT(4) withdrawal. At diagnosis seven patients were euthyroid, 14 with subclinical hypothyroidism, and two with overt hypothyroidism. Median follow-up was 4.7 years. At last follow-up visit, none of the seven euthyroid patients had developed hypothyroidism. Three of the 14 patients with subclinical hypothyroidism recovered a normal thyroid function while only one patient showed an increase in TSH level. By serological screening we identified three patients with other autoimmune disorders. In young patients with normal or mildly increased TSH levels and minimal echographic changes, AIT may remain stationary for years. In fact, patients with subclinical hypothyroidism recover a normal thyroid function in approximately 20% of cases. In patients with subclinical hypothyroidism and goiter, LT(4) therapy may induce thyroid size reduction. Screening for other autoimmune disorders is useful to identify patients that need further diagnostic assessment.

Multicentric preliminary report for endoscopic treatment of Vesico-Ureteral reflux using Polyacrylate-Polyalcohol Copolymer Particles in Glycerol and Water (Vantris)

PURPOSE This polyacrylate-polyalcohol was developed in the laboratory, pursuant to ISO10993-1:2003 Standards, both in vitro and in animals. The substance is a synthetic, non-absorbable type, with low bulking reaction, manually injectable. A preliminary report of patients with at least 1-year follow up is presented. clinical, ultrasound, scintigraphy, urine, laboratory were performed by means of cysto-video-urodynamics. MATERIAL AND METHODS Out of 74 patients injected with this substance, 52 have been followed up for more than one year. The average injection age was 38 months and the number of injected ureters was 75, 35 right and 40 left. Presenting 3 grade V, 11 grade IV, 34 grade III units and 27 grade II units, a close circuit TV system and 23-gauge needles were used. The volume that was injected manually was: 0.2 mL-1 mL per unit with a median of 0.66 mL. The echographic and cysto-video-urodynamyc and clinical follow-up was performed between 16 and 24 months with a mean follow-up of 20 months. RESULTS There were no echographic changes. The complications were in 3(5,7%) patients with urinary infections, 3(5,7%) with fever and 3(5,7%) with lumbar pain after the injection. Antibiotics were stopped after 10 days of treatment. In 67 (89,3%) kidney units, reflux was eliminated, 5 (6,6%)Kidney units, reflux was improved to grade I and in 4(5,3%) Kidney units, the implantation failed with 2 grade III and 2 grade IV. CONCLUSIONS In this number of patients, polyalcohol-polyacrylate has shown to be easy to work with. Given the characteristics of the material, since this is a permanent material, it has presented no complications and thus becomes an attractive material as the first choice for permanent treatment of vesico-ureteral reflux.

Accuracy of endosonography in the staging of rectal cancer treated by radiotherapy

Endosonography is the best available method for the pretherapeutic staging of rectal cancer. The present prospective study was to determine the influence of previous radiotherapy, widely used in the management of this tumour, on the accuracy of endosonography. A complete endosonographic examination was performed just before surgery in 40 patients with rectal cancer. Endosonographic and pathological staging were compared in group A, 21 patients without previous radiotherapy, and group B, 19 patients with preoperative radiotherapy. While the endosonographic accuracy for lymph node involvement was similar in the two groups (85 per cent compared with 84 per cent), wall invasion was correctly ascertained in 86 per cent in group A but in only 47 per cent in group B (P less than 0.05). After irradiation, the thickening of the rectal wall and the poor visualization of the hyperechoic layers hampered interpretation. Post-radiotherapy inflammation and/or fibrosis probably explained the echographic changes. Radiotherapy therefore altered endosonographic staging of rectal cancer. New interpretation criteria are needed for evaluation and follow-up of rectal cancer treated by radiotherapy.

Is rectovaginal endometriosis a progressive disease?

The purpose of this study was to observe the natural history of untreated asymptomatic rectovaginal endometriosis. This was a prospective, observational study. Eighty-eight patients with untreated asymptomatic rectovaginal endometriosis were followed for 1 to 9 years. Pain symptoms and clinical and transrectal ultrasonographic findings were evaluated before and every 6 months after diagnosis. Two patients had specific symptoms that were attributable to rectovaginal endometriosis that was associated with an increase in lesion size and underwent surgery. In 4 other patients, the size of the endometriotic lesions increased, but the patients remained symptom free. The estimated cumulative proportion of patients with progression of disease and/or appearance of pain symptoms that were attributable to rectovaginal endometriosis after 6 years of follow up was 9.7%. For the remaining patients, the follow-up period was uneventful, with no detectable clinical nor echographic changes of the lesions and with no appearance of new symptoms. Progression of the disease and appearance of specific symptoms rarely occurred in patients with asymptomatic rectovaginal endometriosis.

Study of Renal Metabolic Disturbances Related to Renal Lithiasis at School Age in Very-Low-Birth-Weight Children

We studied 34 asymptomatic children who were born with a very-low-birth-weight (VLBW) and had no perinatal history of acute renal failure nor treatment with furosemide. The study was done at preschool or school age, looking for echographic changes and renal tubular disturbances which are known to predispose to renal lithiasis. The results were compared with those of a control group of 18 children who had been born at term with a body weight >2,500 g. One or more renal tubular disturbances were found in 64.70% of the VLBW children. Most frequently found were decreased ammonium excretion in response to furosemide (38.23%), enhanced N-acetylglucosaminidase excretion (35.29%), hypercalciuria (26.47%), and hypocitraturia (23.53%). Echography revealed renal cortical hyperechogenicity (17.65%) and renal lithiasis (8.82%) in some of the VLBW children. We found a significant positive correlation (r = 0.7) between the perinatal level of plasma phosphate and the total amount of H⁺ excreted in response to furosemide at preschool or school age. Because these renal tubular anomalies may be precursors of future lithiasis, and the renal function and echography tests are not invasive, we suggest that renal tubular function be measured and followed up in every VLBW child, particularly when perinatal hypophosphatemia has occurred.

Echographic thyroid changes in iodine deficiency and excess

Echographic thyroid changes in iodine deficiency and excess

Randomised controlled trial of efficacy of albendazole in intra-abdominal hydatid disease

The efficacy of albendazole in hydatid disease is still unclear, because there has been no study that assessed the status of the parasite after treatment. The significance of albendazole- induced echographic changes in the cyst therefore cannot be judged. We did a prospective, controlled, randomised, open study of albendazole in patients with liver hydatid disease, and assessed parasite viability after treatment. 18 patients received no albendazole treatment (controls), 18 received albendazole (10 mg/kg daily) for 1 month (group A), and 19 received the drug for about 3 months (group B). Echography was done before and during treatment; all patients underwent surgery on completion. Parasite (protoscolex viability and development of cysts in mice) and ultrastructure studies were done for all cysts removed. 8 (50%) of cysts in the control group, 13 (72%) in group A, and 16 (94%) in group B were non-viable (p=0·015). Protoscolex and cyst viability were significantly (p=0·039 and p=0·018, respectively) lower in treated patients than in controls. Treatment was also significantly associated with total cyst membrane disintegration. 68% of cysts treated for 3 months showed echographic changes, and only 1 of 20 cysts showing echographic changes during treatment was judged viable. The efficacy of albendazole at a dose of 10 mg/kg daily for 3 months suggests that it is a suitable alternative to surgery in uncomplicated hydatid liver disease, as initial treatment.

Transient renal medullary hyperechogenicity in ultrasound studies of neonates: Is it a normal phenomenon and what are the causes?

A prospective ultrasound study of the renal morphology of 51 neonates with no clinical signs of renal impairment showed transient medullary hyperechogenicity of varying intensity in 37%. These findings were made in the first few postnatal days, were not accompanied by any other echographic changes, and disappeared again within the first week of life. They were encountered twice as often in full-term as in premature babies. In parallel with this phenomenon, the concentration of Tamm-Horsfall protein, calcium, and uric acid, and the osmolality were determined in the daily urine of 44 of these neonates. The analyses did not provide any definite clues as to the etiology of the ultrasound findings. It is therefore suggested that the term "Tamm-Horsfall nephropathy or proteinuria" should no longer be used for such sonographic phenomena in the neonatal kidney, but rather, they should be regarded as normal. Furthermore, the term "tubular stasis nephropathy" should be reserved for cases with clinically demonstrable impairment of renal function.

Findings of endoscopic ultrasonography (EUS) in diagnosis of chronic pancreatitis -echographic changes of the pancrdatic parenchyma including aging-

Findings of endoscopic ultrasonography (EUS) in diagnosis of chronic pancreatitis -echographic changes of the pancrdatic parenchyma including aging-

Effect of Respiration on the Echocardiogram in Children with Cystic Fibrosis

Respiration-related cyclic variation was noted in echocardiographic measurements of right and left ventricular end-diastolic dimension. D-E amplitude of the anterior mitral leaflet, and mitral valve E-F slope in 26 children with cystic fibrosis. The observed echographic changes seem to be an exaggeration of the normal physiologic variation seen with respiration. In children with advanced respiratory disease, airway obstruction, rather than cor pulmonale, may be responsible for this exaggeration.

Lymphographic and Echographic Findings in Angioimmunoblastic Lymphadenopathy

Four patients with angioimmunoblastic lymphadenopathy with dysproteinemia (AILD) had lymphograms that did not show a consistent radiographic pattern. Instead, a spectrum of radiologic changes ranging from a moderate increase in lymph node size with slight "foaminess" to total nonopacification was observed. One patient with this disorder had gray-scale echograms that showed enlarged anechoic lymph nodes. The findings in this small group of patients with AILD are indistinguishable from the radiologic and echographic changes seen in malignant lymphoma.

Pulmonary valve fluttering in subpulmonic ventricular septal defect

Three patients with subpulmonic ventricular septal defect and pulmonary valve fluttering by echocardiography are presented. The echographic changes appear identical to that reported with infundibular pulmonic stenosis and the mechanism causing this fluttering is probably similar.

Echographic changes with placental ageing

AbstractAfter 36 weeks gestation the placenta has a distinct echographic appearance which is characterized by rounded transonic areas measuring 1.5 to 4.5 cm. in diameter. Anatomic and histologic study of seven placentas with this echographic appearance has snown no abnormalities or characteristic findings. The recognition of the mature placenta is of clinical use in the determination of dysmaturity and growth retardation, where a single fetal head measurement may be misleading. The changes in the internal consistency of the placenta are most easily identified with a real‐time, water bath, linear scanner (Siemens Vidoson) but may also be seen with a compound contact scanner if non‐storage recording is employed.