Normal Echogenicity Research Articles

Ultrasonography guidance for total splenectomy in donkeys

There are varieties of surgical approaches reported for equine splenectomy and all of them were dealing with the most reachable situation of splenic hilus and easy handling of the spleen. The aim of this work was to establish the normal ultrasound parameters of spleen in donkeys (normal echogenicity, hilus situation, topographic location and correlation with neighboring organs) as a guide to select the best approach for total splenectomy in donkeys. Splenic ultrasound was carried out on six normal donkeys before experimental total splenectomy in the standing position. The splenic topographic location was recorded among 4 rows including 30 squares. These animals were divided into two groups according to the surgical approach of total splenectomy. Total splenectomy after left 16th and 17th ribs partial resection in standing position was carried out in group1 and group 2, respectively. Ultrasonographically, the spleen had homogenously echogenic pattern and appeared hyperechoic to the liver. Only one third of the spleen was located in front of the 16th rib where the hilus and splenic blood vessels were nearly under the 16th rib. The splenic artery and splenic vein were ultrasonographically visualized between the left 16th and 17th ribs 10–15 cm from dorsal midline. This area was the site of the important ligation during total splenectomy. In conclusion, ultrasonography guidance for total splenectomy in donkeys assisted the surgical findings and proved that technique following partial resection of the 17th rib at the standing position is the most convenient surgical approach for total splenectomy in donkeys.

Esophageal Varices: Itʼs Not Always an Uphill Battle

Downhill (proximal) esophageal varices (DEV) are a separate and distinct entity from the more common uphill (distal) esophageal varices. DEV are produced when an obstruction of the superior vena cava (SVC) leads to a downward flow of the venous system towards the portal vein. DEV are rarely seen as the cause of an acute upper gastrointestinal bleed and account for about 0.1% of all cases of variceal bleed. While there are many causes of SVC obstruction, catheter-associated SVC stenosis is the most frequently reported etiology in patients presenting with an acute variceal bleed. A 66 year old man with history of end stage renal disease on dialysis complicated by difficult access status post right upper extremity hemodialysis reliable outflow (HeRO) graft presented with melena and hemoglobin of 5.3 gm/dL. He underwent urgent endoscopy that demonstrated 3 columns of large proximal esophageal varices originating from the proximal esophagus and extending distally, one with nipple sign indicative of recent bleeding that was successfully banded. Abdominal ultrasound showed normal liver size and echogenicity. Hepatic enzymes were within normal limits (AST 24 U/L, ALT 25 U/L, and ALP 122 U/L). CT chest revealed no evidence of portal hypertension, however extensive chest wall venous collaterals were noted concerning for central venous stenosis. Vascular surgery was consulted for HeRO graft removal prior to IR stenting of SVC stenosis with no further evidence of bleeding. DEV are a rare form of varices seen as a result of SVC occlusion. Obstruction of the SVC shunts blood from systemic circulation into the esophageal plexus, predominantly the upper two-thirds. Bleeding DEV are most frequently noted in patients with central venous catheters. This is only the second case reported of a patient with SVC stenosis due to HeRO graft leading to DEV. There are no definitive recommendations on how to manage DEV, but addressing the underlying obstruction is the mainstay in treatment. There has been no data to address the use of somatastatin analogues for the use of bleeding DEV, although they would likely be of little benefit as the underlying etiology of DEV is not related to portal hypertension. Endoscopy and banding however do have a role in temporizing active bleeding. There is also currently no evidence on the use of beta-blockers for secondary prevention as relieving the obstruction should be a priority to prevent further bleeding.1810_A Figure 1. Gastroesophageal junction1810_B Figure 2. Proximal to mid-esophagus1810_C Figure 3. Esophageal varices post banding

Trans-scrotal ultrasonography evaluation of the cross-bred Ongole bulls

Very limited information is available on the trans-scrotal ultrasonography of cross-bred Ongole bulls with scrotal swelling in India. The present study was carried out on the bulls presented to the hospital with the history of scrotal swelling. Haematology revealed increased leucocyte count, neutrophilia and mild reduction in haemoglobin levels. Microscopic evaluation of the semen revealed abnormal morphology and the presence of the dead spermatozoa. Trans-scrotal ultrasonography helps in the differential diagnosis of scrotal disorders and to identify the appropriate aetiology for developement of the condition. On ultrasonography, all the bulls showed abnormal scrotal morphology. Among these, one had the presence of normal echogenicity testes which are surrounded by the anechoic fluid which will cover by a hyper echoic scrotal skin. The second one showed the anechoic fluid was mixed with the hyper echoic fibrinous threads and degenerative changes in one testis. Third bull showed the diffused hyper echoic threads scattered within the anechoic fluid and different echogenicity of the two testes. In conclusion, trans-scrotal ultrasonography is helpful in the differential diagnosis of the scrotal swells in large animals.

Does normal substantia nigra echogenicity make a difference in Parkinson's disease diagnosis? A real clinical practice follow-up study.

Substantia nigra hyperechogenicity (SN+) detected by transcranial ultrasound (TUS) is useful for Parkinson's disease (PD) diagnosis. Approximately 15% false negative results of unknown significance are reported. However, most TUS studies are transversal, and diagnosis of PD may change during follow-up. Analysis of our prospective registry of TUS in clinical practice, selecting patients with sufficient bone window, to whom TUS was performed because of suspected PD, and a minimum of 3-year follow-up. Subjects were classified regarding SN echogenicity (SN+/SN-). 172 patients (122 SN+, 50 SN-), mean age 71years (25-90), were included. At the end of follow-up, PD diagnosis was retained by 91% SN+ vs. 54% SN- subjects (p < 0.0001), while final diagnosis of atypical parkinsonism (3%SN+ vs. 16%SN-, p:0.0059) was more frequent in SN-. Dopaminergic therapy response was associated with SN+ (88% SN+ vs. 50% SN-, p < 0.0001), as were abnormal DaTSCANs (90%SN+ vs. 56%SN-, p 0.0027). SN echogenicity had 80% sensitivity and 68% specificity for PD diagnosis, while SPECT had 91% and 73%, respectively. SN+ was the only baseline predictor of keeping PD diagnosis at the end of follow-up, with an odds ratio of 12 (95% CI 3-42) (p < 0.001). In our sample of patients with suspected PD, SN hyperechogenicity predicted PD diagnosis in the long term with a high odds ratio. Conversely, a baseline normal SN echogenicity was associated with a poorer response to PD therapy and change to a different diagnosis from PD. Normal SN appears to be a caveat for clinicians to check for atypical parkinsonism features during follow-up.

Exposure to environment chemicals and its possible role in endocrine disruption of children from a rural area

Endocrine disrupting chemicals (EDCs), including pesticides and metals, are present in rural areas, endangering the health of exposed populations. This work aimed to investigate the possible association between the exposure to these xenobiotics and thyroid dysfunction in children living in a rural community of Southern Brazil. Fifty-four children aged 5–16 years participated in this study. Peripheral biomarker evaluations were performed in periods of low and high exposure to pesticides. Thyroid ultrasonography was evaluated in the high exposure period. Blood levels of chromium (Cr), manganese (Mn), mercury (Hg), and lead (Pb), as well as hair Pb levels were positively correlated with thyroid stimulating hormone (TSH) concentrations and negatively associated with free thyroxine (fT4) levels in the low exposure period. Prolactin was positively associated with hair Mn in both periods. In the ultrasound tests, the majority of children presented a normal echogenicity of thyroid. Glucose was inversely associated with the biomarker of exposure to cholinesterase inhibitor insecticides, butyrylcholinesterase (BuChE). Lipid profile was above the recommended levels in both periods. In summary, our results show that children environmentally exposed to a mixture of xenobiotics in an agricultural community may have health impairments, especially on thyroid function, dyslipidemia, and glucose homeostasis disruption.

Study of the Ultrasound Appearance of the Normal Parathyroid Using an Intraoperative Procedure.

This study was designed to confirm the echogenicity of normal parathyroid glands using intraoperative ultrasound (US). Between October 2015 and January 2016, normal parathyroid glands were examined with an intraoperative US transducer during thyroidectomy procedures in 13 patients with thyroid disease. According to the findings from intraoperative US, routine percutaneous US of normal parathyroid glands was performed in a group of adults. On the basis of previous information on normal parathyroid echogenicity, a series of parathyroid diseases that were proved by surgery and histopathologic analyses were retrospectively reviewed. The presence of residual normal parathyroid in the lesion on US imaging, which was defined as the residual parathyroid sign in this study, was reviewed and correlated with histopathologic results. In the intraoperative US group, 23 parathyroid glands were scanned intraoperatively, and 21 (91.3%) were hyperechoic, homogeneous in texture, and oval. In the routine percutaneous US group, 106 parathyroid glands were found in total, and 96 (90.5%) of the glands had hyperechoic and homogeneous echogenicity, with 75 (70.8%) being oval. In the review of parathyroid diseases, 33 parathyroid glands in 30 cases were reviewed, with a positive residual parathyroid sign in 7 (21.2%) parathyroid glands, presenting with a hyperechoic rim in the margin, and 4 of them (12.1%) were confirmed by histopathologic results. The normal parathyroid had hyperechoic echogenicity on both intraoperative and percutaneous US imaging. Residual tissue of parathyroid glands can also be observed in some parathyroid abnormalities with an echogenic appearance on US imaging and confirmed by histopathologic results.

Primarni retroperitonealni mucinozni cistadenom – prikaz slučaja

Objective. Primary retroperitoneal mucinous cystadenoma is rare, appearing more commonly in women and very rarely in men. Case report. We present a 50-year-old female with retroperitoneal cystic formation under the left kidney seen accidentally during an ultrasonographic examination. The cyst measuring 88x77 mm, with an irregular shape, smooth walls with several small cystic formations at the bottom was seen. Cystic echinococcosis was considered in the differential diagnosis and IHA echinococcosis and ELISA echinococcosis tests were performed. Biohumoral and tumor markers were normal. Repeated ultrasound examination showed both kidneys of normal dimensions, parenchyma thickness and echogenicity, with no signs of hydronephrosis and calculosis. Each kidney had cortical cyst, beside the cyst of about 25 mm in diameter in the left kidney. CT revealed left-sided infrarenal retroperitoneal tumor and MRI of the abdomen and pelvis was proposed because of the size, density and calcification of the tumor wall. MRI shows multilocularis cystic formation with septations measuring 92x76 mm, with several small cystic lesions filled with dense content, caudal to the left kidney and between intestinal wings. In order to clarify the etiology of the described changes and because the patient was suffering from abdominal pain laparotomy was performed and retroperitoneal cyst size 100x70x80 mm was extirpated in toto. After a successful operation the postoperative period was uneventful. Pathohistological finding showed retroperitoneal mucinous cystadenoma. Conclusion. Primary retroperitoneal mucinous cystadenoma is a rare tumor, difficult to diagnose. Definite diagnosis is based upon histopathology. The treatment is exclusively surgical.

Decreased ultrasound echogenicity as a thyroid hypofunction marker and correlation with autoantibody levels

Background/Aim. The value of ultrasound in functional disorders can be significant. That is why the question arises on the use of ultrasound examination of thyroid gland and its echogenicity as a screening method in early detection of disfunctions, of the gland primarily subclinical and clinical forms of hypothyreoidism. The objective of this paper was to determine antibodies of thyroid peroxidase (anti-TPO) and thyroglobuline antibodies (anti-TG) increase frequency in relation to the character of ultrasound echogenicity as well as to estimate the frequency of subclinically and clinically obvious hypothyreoidism in relation to the changed echogenicity. Methods. Study included 656 patients in outpatient clinic during 2014. All examinees underwent ultrasound examination of thyroid gland, the blood was taken for determination of free thyroxine (FT4), thyroidstimulating hormone (TSH), anti-TPO and anti-TG. The patients were divided into two groups; the group A with normal echogenicity of thyroid gland tissue, and the group B with decreased echogenicity. The group B was divided into two subgroups, B1 with a mildly decreased and B2 with significantly decreased echogenicity. Results. TPO antibody, TSH and TG antibody positivity and their mean values in the group B were significantly higher, as well as in subgroups B1 and B2, in relation to the group A (p &lt; 0.001). In the group A, only 4 (1%) examinees were indicated with subclinical hypothyreoidism. In the group B, the sublinical hypothyreoidism was indicated in 42, while the clinical hypothyreoidism was indicated in 16 examinees. Fifty-eight (25%) examinees suffered from thyroid gland altered function. In the subgroup B1, 16 examinees were indicated with subclinical and 4 with clinical hypothyreoidism. Twenty (11%) examinees suffered from altered thyroid function. In the group B2, the subclinical hypothyreoidism was found in 26 examinees, while the clinical hypothyreoidism was found in 12. Thirty-eight (76%) examinees suffered from altered thyroid function. Conclusion. The ultrasound screening of thyroid gland plays an important role in early detection of thyroid disfunction, i.e., sublinical and clinical hypothyreoidism. Decreased ultrasound echogenicity represents the significant marker of altered thyroid gland function. In these persons we have determined the high percentage of subclinical and clinical hypothyreoidism frequency.

Ultrasound of muscular diseases in children and adolescents

The increasing number of treatable hereditary neuromuscular diseases in children requires adiagnostic tool that can quickly, safely, and noninvasively identify affected patients directly after birth or when showing initial clinical symptoms. With clinical analysis alone, this is very difficult. Near-field sonography of skeletal muscles has gradually become established as asuccessful method over the last 35years. Examination is performed using a strictly standardized protocol in isotopic muscle regions and with standardized sections and application parameters. Interpretation is performed with specific assessment criteria and nomenclature for the description of normal and pathological muscle architecture and echogenicity. This is sonographic tissue characterization. Using case studies, the sonoanatomy and sonopathology of selected myo- and neuropathies, metabolic, inflammatory, and other lesions are illustrated. We present their differential diagnosis by texture and echogenicity analysis. Affected persons are identified in 70% up to 100% of cases, depending on the entity; specificity is less dependent on experience and training. Of the 12disorders presented in this article, 6are causally/symptomatically treatable today. Standardized myosonography is the imaging modality of first choice for detection of neuromuscular diseases. High frequency (8-22 MHz) linear array transducer. Highly standardized examination modality. Simultaneous, paired comparison of affected persons and controls. If necessary, muscle tissue biopsy only after ultrasonic determination of asuitable area.

Ultrasound assessment of rectus femoris and anterior tibialis muscles in young trauma patients

PurposeQuantitative and qualitative changes of skeletal muscle are typical and early findings in trauma patients, being possibly associated with functional impairment. Early assessment of muscle changes—as evaluated by muscle ultrasonography—could yield important information about patient’s outcome.MethodsIn this prospective observational study, we used ultrasonography to evaluate the morphological changes of rectus femoris (RF) and anterior tibialis (AT) muscles in a group of young, previously healthy trauma patients on enteral feeding.ResultsWe studied 38 severely injured patients (median Injury Severity Score = 34; median age = 40 y.o.) over the course of the ICU stay up to 3 weeks after trauma. We found a progressive loss of muscle mass from day 0 to day 20, that was more relevant for the RF (45%) than for the AT (22%); this was accompanied by an increase in echogenicity (up to 2.5 by the Heckmatt Scale, where normal echogenicity = 1), which is an indicator of myofibers depletion.ConclusionsUltrasound evaluation of skeletal muscles is inexpensive, noninvasive, simple and easily repeatable. By this method, we were able to quantify the morphological changes of skeletal muscle in trauma patients. Further studies may rely on this technicque to evaluate the impact of different therapeutic strategies on muscle wasting.

P297 Atypical carpal tunnel syndrome caused (mimicked) by bifid median nerve

Objectives We report a case about a patient with atypical carpal tunnel syndrome due to bifid median nerve, verified by nerve ultrasound. Methods 38-year old female patient had low scores both on Symptom severity scale and Functional status of Boston Carpal Tunnel Syndrome Questionnaire but neurophysiological examination showed significantly decreased motor amplitude with mildly prolonged distal latency and mildly decreased sensory amplitude and nerve conduction velocity of the median nerve. Electromyography (EMG) of abductor pollicis brevis muscle revealed normal findings. High resolution peripheral nerve ultra sound (US) showed normal echogenicity of the nerve, but revealed a bifid nerve: median nerve with proximal bifurcation without any obvious sign of compression or anastomosis. Result and discussion Routine nerve conduction studies referred to severe carpal tunnel syndrome which could have been reported to hand surgery. Ultrasound revealed an anatomic variant instead of severe compression neuropathy, explaining atypical nerve conduction findings. Conclusion Beside the routine nerve conduction studies, high resolution peripheral nerve ultrasound examination seems to be highly recommended in order to ensure compression or anatomic variants, especially if the results are not typical to carpal tunnel syndrome. Significance Use of peripheral nerve ultrasound should be a part of everyday routine in neurophysiology labs in order to improve diagnostic accuracy and therapeutic outcome.

Lower urinary tract obstruction: fetal intervention based on prenatal staging.

The authors present an overview of lower urinary tract obstruction (LUTO) in the fetus with a particular focus on the insult to the developing renal system. Diagnostic criteria along with the challenges in estimating long-term prognosis are reviewed. A proposed prenatal LUTO disease severity classification to guide management decisions with fetal intervention to maintain or salvage in utero and neonatal pulmonary and renal function is also discussed. Stage I LUTO (mild form) is characterized by normal amniotic fluid index after 18weeks, normal kidney echogenicity, no renal cortical cysts, no evidence of renal dysplasia, and favorable urinary biochemistries when sampled between 18 and 30weeks; prenatal surveillance is recommended. Stage II LUTO is characterized by oligohydramnios/anhydramnios, hyperechogenic kidneys but absent renal cortical cysts or apparent signs of renal dysplasia and favorable fetal urinary biochemistry; fetal vesicoamniotic shunting (VAS) or fetal cystoscopy is indicated to prevent pulmonary hypoplasia and renal failure. Stage III LUTO is oligohydramnios/anhydramnios, hyperechogenic kidneys with cortical cysts and renal dysplasia and unfavorable fetal urinary biochemistry after serial evaluation; fetal vesicoamniotic shunt may prevent severe pulmonary hypoplasia but not renal failure. Stage IV is characterized by intrauterine fetal renal failure, defined by anhydramnios and ultrasound (US) findings suggestive of severe renal dysplasia, and is associated with death in 24h of life or end-stage renal disease (ESRD) within the first week of life; fetal vesicoamniotic shunt and fetal cystoscopy are not indicated.

Hermafroditismo verdadeiro na espécie canina

Background: Hermaphroditism or intersex is a general term that includes various congenital anomalies of the genital system which is used to define animals with ambiguous sexual characteristics. It occurs in domestic animals, more commonly in pigs and goats, and rarely in horses, dogs, sheep, and cattle. The prevalence of hermaphroditism varies a lot among breeds and species and is higher in groups with a high degree of consanguinity. Therefore, the objective of this report is to describe a case of canine hermaphroditism in a dog with male phenotype, as well as the anatomical and hormonal findings, and classification of the hermaphroditism exhibited by the animal studied.Case: A 1-year-old, mongrel, 5 kg dog was referred to the UHV-UECE due to the presence of a slit on the lower quadrant of the abdomen, caudal to the umbilical scar. At examination, the animal exhibited normal rectal temperature, no alterations of palpable lymph nodes, and a satisfactory body condition score. The pubic area had 2 testicles, each one in a different scrotum, 1 to the right and 1 to the left of the slit. A prepuce with no apparent function was present cranially to the slit, closer to the umbilical scar. At the other extremity of the slit, on the pubic region, there was a flaccid structure similar to a penis (micropenis) with no penile bone and no function. The slit was open until the area ventral to the anus, where the urethra was detected. The animal exhibited a behavior of territory demarcation with urine typically seen in male dogs. Orchiectomy and slit correction surgery were performed. Pre-surgical exams included: complete blood count and hormonal doses of estradiol, testosterone, and progesterone. Abdominal ultrasound was performed to assess presence of sexual glands and gonads. The hormonal exam revealed: estradiol 56.39 pg/mL; testosterone 127.9 ng/mL; progesterone 0.892 ng/mL. A uterus was not detected on ultrasound examination. Ovaries were seen on their typical anatomical position; they were symmetrical and had normal sizes. There was a normal size prostate in the pelvic area, exhibiting normal texture and echogenicity. No other abnormalities were seen and the owner opted for no further surgical intervention.Discussion: Testosterone predominance explains the male behavior and appearance, demonstrating that the testis were prevalent over the ovaries. The occurrence of XX males has been reported. The genetic cause is the absence of the SRY chromosome, which has a fundamental role on activation of the SOX gene, which is responsible for sex determination. Clinically, a true hermaphrodite can exhibit different degrees of genital ambiguity; they can be diagnosed during puberty with the emergence of heterosexual characteristics, or as an adult, with infertility or gonadal neoplasia. True hermaphrodites are individuals with testicular and ovarian tissues, either combined in one gonad (ovotestis) or present as two separate gonads. The presence of ovaries and testicles can be confirmed by histology, which was not performed in this study. However, ultrasound findings (prostate and ovaries), and the presence of normal testis and external genitalia without a defined penis or vulva are in accordance with the description of a true hermaphrodite.

Relationship between rapheal echogenicity and personality as possible markers of a disposition to develop depressive and anxiety disorders

Early diagnosis of anxiety and depression may be facilitated by the use of neurobiological markers. In depression and panic disorder, transcranial sonography (TCS) has revealed decreased echogenicity of the brainstem raphe (BR). The aim of the present study was to detect whether decreased echogenicity of the BR correlates with personality features described in the five-dimension model, especially neuroticism. We examined 100 healthy volunteers using quantitative and qualitative TCS, the five-dimension revised NEO Personality Inventory, Beck´s scales of anxiety and depression, and the Social Re-adjustment Rating Scale (SRRS). Visual BR anechogenicity was found in 11 subjects, BR hypoechogenicity in 29 subjects, and normal BR echogenicity in 60 subjects. The visual assessment correlated with the digital assessment. Comparing the groups with visual BR anechogenicity and BR normoechogenicity, only increased SRRS score and increased agreeableness z-score were significant. Our hypothesis that BR hypoechogenicity reflects an inclination for depression and anxiety characterized by the personality dimension neuroticism was not supported. However, this disposition may be present in a different state, such as stress.

Shear-wave ultrasound elastography of the liver in normal-weight and obese children.

Background The identification and subsequent management of liver diseases in children is challenging due to the lack of non-invasive imaging biomarkers. Ultrasound shear-wave elastography (US-SWE) is an emerging imaging technique which can quantitatively assess liver stiffness and may be useful as a tool in the management of liver disease in overweight and obese children. Purpose To evaluate US-SWE velocities of the liver in normal-weight and obese children, to correlate US-SWE findings with age and body-mass-index (BMI), and to compare US-SWE values with qualitative assessment (i.e. normal versus abnormal echogenicity) of the liver by conventional US. Material and Methods A cohort of 300 children (mean age, 9.9 ± 5.3 years; age range, 0.06-18.9 years) were studied, comprising 176 normal-weight and 124 obese participants. In each patient, both US-SWE and conventional US of the liver were obtained. Three pediatric radiologists individually and in consensus determined whether liver parenchyma was of normal or abnormal echogenicity. Results US-SWE velocities differed between normal-weight and obese children (1.08 ± 0.14 versus 1.44 ± 0.39 m/s; P < 0.001), but not by gender. Multivariate linear regression demonstrated US-SWE velocity to be primarily associated with age in normal-weight children ( P < 0.05) and with BMI in obese children ( P < 0.001). In the obese group, mean US-SWE velocity was statistically higher in participants with abnormal echogenic livers than in those with normal-appearing livers (1.53 ± 0.38 vs. 1.17 ± 0.27). The difference was not significant in the normal-weight group. Conclusion US-SWE provides a useful quantitative imaging biomarker for evaluating liver stiffness in children.

Patellar tendon healing after anterior cruciate ligament reconstruction in football players

Introduction:To investigate the healing process of the harvested patellar tendon at 12±2 and 24±2 months following Bone-Patellar-Bone (BTB) Anterior Cruciate Ligament (ACL) reconstruction.Methods:30 football players were enrolled in our study and examined at 12±2 and 24±2 months postoperatively. Donor and contralateral tendons evaluated with a high frequency ultrasound transducer. The maximum anteroposterior (MAP) and maximum transverse (MT) diameters of the patellar tendon and associated defect at the site of the tendon incision measured at its proximal, middle and distal thirds. The presence of vascular flow was examined with Doppler imaging. Echogenicity of the patellar tendon defect was graded as low, mixed or normal compared to the contralateral tendon.Results:There was no statistically significant difference between the mean MAP and MT diameters of the donor tendons at 12±2 and 24±2 months postoperatively (P>0.05). The mean MAP and MT diameters of the patellar tendon defect at 24±2 months were significantly smaller compared to 12±2 months postoperatively (P<0.01). The mean MAP diameter of the harvested tendon was significantly greater at all measured sites in comparison to the contralateral tendon at 12±2 and 24±2 months postoperatively (P<0.01). There was no statistically significant difference between the mean MT diameters of the donor and healthy tendons at 12±2 and 24±2 months postoperatively (P>0.05). At 12±2 months, the mean MAP diameter of the patellar tendon defect was 4.0±2.1 mm, 4.7±2.8 mm and 4.1±2.4 mm at the proximal, middle and distal third of the tendon respectively. The mean MT diameter of the defect was 3.3±2.2 mm (proximal third), 2.9±1.6 mm (middle third) and 2.1±0.9 mm (distal third). 2 of tendon defects showed low echogenicity, 6 mixed echogenicity, 2 patients normal echogenicity. At 24±2 months the mean MAP diameter of the patellar tendon defect was 0.3±0.3 mm, 0.4±0.4 mm and 0.3±0.3 mm at the proximal, middle and distal third of the tendon respectively. The mean MT diameter of the defect was 0.3±0.3 mm (proximal third), 0.2±0.2 mm (middle third) and 0.2±0.2 mm (distal third). 27 of patients demonstrated normal echogenicity, 1 low echogenicity, while 2 mixed echogenicity. No tendon exhibited any signs of neovascularization at 12±2 and 24±2 months postoperatively.Conclusions:Patellar tendons after BTB ACL reconstruction were characterized by increased thickness at 12±2 and 24±2 months postoperatively. Solid healing were evident in 2 patients by 12±2 months and in 27 by 24±2 months. No inflammatory changes were observed at 12±2 and 24±2 months postoperatively.picture 1ultrasonographic image of patellar tendonpicture 2ultrasound

An Unusual Clinical Presentation of Solitary Fibrous Tumor in the Oral Cavity

Solitary fibrous tumor is a rare neoplasm of mesenchymal origin that usually affects the pleura. This rarity becomes more relevant in the oral cavity since the clinical features are nonspecific. A 66-year-old female patient presented with a 3-month history of a swelling in the floor of the mouth, measuring 2 cm in greatest diameter, and pain symptomatology. Occlusal and panoramic radiographs showed no bone involvement. Ultrasonography of the submandibular and parotid salivary glands revealed normal morphology, dimensions, and echogenicity. During this exam, a nodular image of low echogenicity measuring about 2.7 × 1.8 cm was detected. An excisional biopsy was performed and histopathological analysis revealed a well-defined tumor-like lesion with alternation between hypercellular areas without a defined pattern and hypocellular areas. On immunohistochemistry, the tumor was positive for CD34 and CD99 and negative for α-SMA, S-100, and bcl-2. Combining the histopathological and immunohistochemical features, the diagnosis was solitary fibrous tumor. The patient is under periodical clinical follow-up and shows no signs of recurrence 7 months after surgical excision of the tumor. The combination of clinical-pathological and immunohistochemical features is necessary for the diagnosis.

A pilot study on predictors of brainstem raphe abnormality in patients with major depressive disorder

BackgroundHypo/anechogenicity of the brainstem raphe (BR) structures has been suggested as a possible transcranial parenchymal sonography (TCS) marker associated with depression. AimThe aim of this study was to analyze possible association of the abnormal BR echogenicity in patients with major depression when compared to healthy controls, and to evaluate its clinical and genetic correlates. MethodsTCS was performed in 53 patients diagnosed as major depressive disorder (MDD) without psychotic symptoms and in 54 healthy matched controls. Results: The TCS detected BR abnormalities were significantly more frequent in MDD patients (35 out of 53; 66%) in comparison to matched controls (5 out of 56; 9%). The prevalence of short allele (s) homozygocity in the length polymorphism of the promoter region of the serotonin transporter gene (5-HTTLPR) was significantly higher in MDD patients relative to those with normal BR echogenicity. A stepwise statistical discriminant analysis revealed statistically significant separation between MDD patients with and without BR abnormalities groups based on the four predictors combined: the Hamilton Anxiety Rating Scale item 5 („difficulty in concentration, poor memory“), presence of social phobia, s allele homozygocity of the 5-HTTLPR polymorphism, and presence of generalized anxiety disorder. LimitationsCross-sectional design and heterogenous treatment of depressed patients. ConclusionsReduced BR echogenicity in at least a subgroup of MDD patients may reflect a particular phenotype, characterized by more prevalent comorbid anxiety disorders, associated with particular genetic polymorphisms and neurotransmitter(s) deficits, most probably altered serotonergic mechanisms.

Cognitive Performance Patterns in Healthy Individuals with Substantia Nigra Hyperechogenicity and Early Parkinson's Disease.

Introduction: Hyperechogenicity of the substantia nigra (SN+) is a risk marker for Parkinson’s disease (PD) which can be detected before the diagnosis. In healthy individuals, SN+ has been associated with slight deficits in specific cognitive functions, suggesting cognitive impairment as a possible pre-diagnostic marker for PD. However, the pattern of cognitive deficits associated with SN+ has not yet been compared with those present in PD.Methods: Data of 262 healthy individuals with normal echogenicity (SN-) and 48 healthy individuals with SN+ were compared with 82 early stage PD patients using the “Consortium to Establish a Registry for Alzheimer’s disease” test battery. First, the test clusters (factors) were identified using a principal component analysis (PCA). Mean group performance of cognitive tests belonging to distinct factors, according to the PCA, and single subtest performances were compared using analyses of variance. Second, the number of individuals with abnormal cognitive performances (z-score < -1.0) were compared between groups.Results: Verbal memory, semantic and executive function, and praxis were identified as components of cognitive performances. The SN+ group performed significantly worse than the SN- group in tests assessing semantic and executive function, with a non-significant decrease in verbal memory. On the subtest level, individuals of the SN+ group scored significantly lower than the SN- group on the Boston Naming Test (BNT; p = 0.008). In all subtests, the percentages of PD patients with values below the cut-off for abnormal performance were higher than in the SN- group. Moreover, more individuals from the SN+ group scored below the cut-off in the BNT (SN- = 8.4%, SN+ = 20.8%, p = 0.01) and TMT-B (SN- = 6.9%, SN+ = 16.7%, p = 0.02), compared to the SN- group.Conclusion: This study confirms poorer performance of healthy individuals with SN+ compared to SN- in specific cognitive domains. However, against the SN- group, the cognitive profile of the SN+ group was not fully consistent with the profile of early PD patients. Our data argues that cognitive impairment associated with SN+ might differ slightly from that seen in early PD. Compensational mechanisms in the early phases of neurodegeneration, and the fact that only a subgroup of SN+ will develop PD, may partly explain these differences.

The study of normal parathyroid echogenicity

Background: Some of the normal parathyroid can be shown on an ultrasound image. To our knowledge, however, either high or low echoic level of the normal parathyroid has been described without the confirmation of an experiment. Therefore, the echogenicity of the normal parathyroid was studied using intraoperative ultrasound. Materials and methods: Between October 2015 and January 2016, the parathyroid was examined in thyroidectomy procedures of 16 contiguous patients with thyroidal disease using an intraoperative array 8 – 18 MHz probe sheathed with a sterilized covering. There were 12 female and 4 male patients with an age range of 29 – 74 years old (mean, 47 ± 15). After one thyroid lobe or whole thyroid gland was removed, the parathyroid was found out by the surgeon. Then the parathyroid was scanned directly and through frontally-padded muscle of the neck, respectively. Results: The pathology results were thyroid papillary carcinoma (n = 11), thyroid medullary carcinoma (n = 2), thyroid adenoma (n = 1), retrosternal nodular goiter (n = 1), and thyroid nodular goiter (n = 1). Totally, twenty-five parathyroids were scanned in operation, including 8 right superior, 6 right inferior, 6 left superior, and 5 left inferior glands. All the parathyroids were visualized as hyperechoic structures, being homogeneous in texture (n = 22, 88%) and oval (n = 20, 80%), round (n = 3, 12%), or strip-like (n = 2, 8%) in shape. The length, width, and thickness averaged 6.8 ± 2.9 mm (range, 4 – 18 mm), 4.3 ± 1.6 mm (range, 3 – 10 mm), and 3.5 ± 1.3 mm (range, 1 – 7 mm). Conclusion: The normal parathyroid was confirmed to have a hyperechoic echogenicity, with most of them being homogenous and round-shaped, and measuring an average size of 6.8 × 4.3 × 3.5 mm through intraoperative ultrasound.