Ultrasound Pattern Research Articles

Lung Ultrasound in the Early Diagnosis and Management of the Mild Form of Meconium Aspiration Syndrome: A Case Report

MAS is a common cause of neonatal respiratory distress in term and post-term neonates. Meconium staining of the amniotic fluid occurs in about 10-13% of normal pregnancies, and about 4% of these infants develop respiratory distress. In the past, MAS was diagnosed mainly on the basis of history, clinical symptoms, and chest radiography. Several authors have addressed the ultrasonographic assessment of the most common respiratory patterns in neonates. In particular, MAS is characterised by a heterogeneous alveolointerstitial syndrome, subpleural abnormalities with multiple lung consolidations, characterised by a hepatisation aspect. We present six cases of infants with a clinical history of meconium-stained fluid who presented with respiratory distress at birth. Lung ultrasound allowed the diagnosis of MAS in all the studied cases, despite the mild clinical picture. All children had the same ultrasound pattern with diffuse and coalescing B-lines, pleural line anomalies, air bronchograms, and subpleural consolidations with irregular shapes. These patterns were distributed in different areas of the lungs. These signs are specific enough to distinguish between MAS and other causes of neonatal respiratory distress, allowing the clinician to optimise therapeutic management.

Alveolar capillary dysplasia with misalignment of pulmonary veins in a premature newborn: the role of lung ultrasound

BackgroundAlveolar capillary dysplasia with misalignment of pulmonary veins (ACD/MPV) is a lethal neonatal lung disorder characterized by the decrease of the alveolar units, abnormalities in the air–blood barrier of the lung, and impaired gas exchange. Typically, it affects a full-term newborn; the symptoms usually start within a few hours after birth, resulting in severe respiratory distress and pulmonary hypertension. In most of the cases, this disorder is refractory to conventional pulmonary support.Case presentationWe report a case of a newborn male of 29 weeks gestational age, with birth weight of 850 g and intrauterine growth restriction. Severe respiratory distress appeared a few minutes after birth; non-invasive ventilatory support was provided in the delivery room and, as a consequence of persistent respiratory failure, he was admitted to the neonatal intensive care unit (NICU) where mechanical ventilation was required.Due to the symptoms and pulmonary ultrasound pattern suggestive of respiratory distress syndrome, surfactant treatment was administered. Lung ultrasound (LU) was used for monitoring the responsiveness to surfactant; severe pulmonary hypertension ensued, followed by respiratory failure, refractory shock, and death within 48 h.Owing to the poor response to the established therapy, ACD/MPV was suspected. The diagnosis was confirmed through autopsy. The main goal of this case report is to show the role of LU for monitoring the evolution of this disorder.ConclusionLU could provide essential information to help diagnose and follow-up the underlying cause of persistent pulmonary hypertension of the newborn in an earlier and more effective way than chest X-ray. LU is suitable for routine monitoring of lung disease in the NICU.

The sonographic pattern of nodule and thyroid fine needle aspiration cytology in the evaluation of thyroid malignancy risk

Introduction: Thyroid fine-needle aspiration biopsy (TFNAB), which is basically planned according to the ultrasonographic features is of clinical importance; since it helps early diagnosis of malignancy, facilitates the selection of patients who will undergo thyroid surgery and prevents unnecessary surgical procedures. In our study, we aimed to evaluate the adequacy of TFNAB as well as the retrospective investigation of the link between the estimated malignancy risk and the descriptive features, radiologic findings and biopsy cytology of patients who underwent ultrasonography guided TFNAB.Methods: In this study, the ultrasonographic characteristics of 659 thyroid nodules belonging to 523 patients who underwent TFNAB between 2018 and 2021 were evaluated. The correlation between the risk of malignancy and demographic data, thyroid hormone levels, and ultrasonographic characteristics of nodules was examined. The diagnostic accuracy performances of European thyroid imaging reporting and data system (EU-TIRADS) classification prepared by the European Thyroid Association (ETA), the risk classification systems recommended by the American Thyroid Association (ATA) and the Society of Endocrinology and Metabolism of Turkey (TEMD) were compared with The Bethesda System for Reporting Thyroid Cytopathology (Bethesda). The adequacy of biopsy was also evaluated. The data which is obtained from the study was statistically analyzed by means of SPSS 20.0 (Statistical Package for the Social Sciences; SPSS Inc. Chicago, IL, USA) program.Results: In this study, the biopsies of 41 (6.2%) among 659 thyroid nodules appeared to be malignant. A statistically significant correlation was detected between malignancy and hypoechogenicity (p=0.011), microcalcification (p=0.005), irregular margins (p=0.028), and accompanying pathological lymph node (p=0.002). Compared to the surgical pathology results, the accuracy that was closest to that of Bethesda System (AUC: 0.778) (Area Under Curve) was found in EU-TIRADS (AUC:0.715). In the biopsies performed in our own endocrinology clinic (43.7% of the total biopsies), the ratio of non-diagnostic results was found to be 8.3%, whereas it was 29.1% in the biopsies performed in other clinics (56.3% of the total biopsies).Conclusion: It should always be kept in mind that, in the cytologic evaluation, the ultrasonographic nodule pattern recommended by the guidelines is very important in the management of patients, because cytology may show false negative and false positive results as well as unclear or non-diagnostic pathological findings. However, clinicians should also understand that classification systems may have strengths and weaknesses. Our study also emphasizes the importance of how experienced a clinic performing biopsy is as well as the role of cytopathologist in obtaining diagnostic results in biopsy.Keywords: Thyroid nodule, neoplasia, ultrasonography, biopsy fine-needle

Evaluation and Classification of Incidentally Detected Splenic Lesions Based on B-Mode and Contrast-Enhanced Ultrasound.

To evaluate B-mode ultrasound (B-US) and contrast-enhanced ultrasound (CEUS) patterns of focal splenic incidentalomas (FSIs), and to correlate ultrasound patterns with benignity and malignancy via histologic examination and/or the clinical course. Between 2004 and 2021, 139 consecutive patients with an FSI detected by B-US were investigated additionally with CEUS. On CEUS, the arterial enhancement (AE) of the FSI (hyperenhancement, isoenhancement, hypoenhancement, and absent enhancement) was analyzed. Subsequently, the malignancy rate according to different B-US echo patterns and CEUS perfusion patterns was determined. The final diagnosis of FSI was malignant in 9/139 (6.5%) and benign in 130/139 (93.5%) cases. The hypoechoic and hyperechoic lesions on B-US with arterial hyperenhancement on CEUS and the echogenic cystic or complex lesions on B-US with predominantly absent enhancement on CEUS were benign in 54/54 (100%) cases. 6/37 (16.2%) hypoechoic lesions on B-US with arterial hypo-/isoenhancement on CEUS and 3/48 (6.3%) of hyperechoic lesions on B-US with an arterial hypo-/isoenhancement on CEUS were malignant. Based on these results, FSIs reveal different malignancy rates depending on the B-US und CEUS patterns, and classification according to these B-US and CEUS patterns may be helpful in further evaluation of an FSI.

Cardiopulmonary Ultrasound Patterns of Transient Acute Respiratory Distress of the Newborn: A Retrospective Pilot Study.

Acute transient respiratory distress in the first hours of life is usually defined as transient tachypnea of the newborn (TTN). TTN is a respiratory self-limiting disorder consequent to delayed lung fluid clearance at birth. While TTN is the most common etiology of respiratory distress near term, its pathogenesis and diagnostic criteria are not well-defined. Lung ultrasound and targeted neonatal echocardiography are increasingly being used to assess critically ill infants, although their combined use to improve diagnostic precision in neonatal intensive care units has not yet been described. This retrospective pilot analysis aimed to identify possible cardiopulmonary ultrasound (CPUS) patterns in term and late preterm infants suffering from transient respiratory distress and requiring non-invasive respiratory support. After retrospectively revising CPUS images, we found seven potential sonographic phenotypes of acute neonatal respiratory distress. Up to 50% of the patients presented with signs of increased pulmonary vascular resistance, suggesting that those patients may be diagnosed with mild forms of persistent pulmonary hypertension of the newborn. Approximately 80% of the infants with a history of meconium-stained amniotic fluid displayed irregular atelectasis, indicating that they may have suffered from mild meconium aspiration syndrome. CPUS evaluation may improve accuracy in the approach to the infants presenting with transient acute respiratory distress, supporting communication with the parents and carrying important epidemiological consequences.

Ultrasound predictors of difficult spinal anesthesia: a prospective single-blind observational study.

Ultrasound showed to improve the precision and efficacy of spinal anesthesia (SA) through the identification of specific structures surrounding the intrathecal space, such as the anterior and posterior complex of dura mater (DM). The aim of this study was to verify the efficacy of ultrasonography in predicting difficult SA trough the analysis of different ultrasound patterns. This prospective single-blind observational study involved 100 patients undergoing orthopedic or urological surgery. A first operator chose by landmarks the intervertebral space where he wanted to perform SA. Then a second operator recorded the visibility of DM complexes at ultrasound. Subsequently, the first operator, blinded to the ultrasound evaluation, performed SA, defined as "difficult" in case of failure, change of intervertebral space, operator exchange, duration >400 seconds or more than 10 needle passes. The ultrasound visualization of only posterior complex or the failure in visualization of both complexes showed a positive predictive value of 76% and 100%, respectively, towards difficult SA vs. 6% when both complexes were visible; P<0.001. A negative correlation was found between the number of visible complexes and both patients' age and BMI. Landmark-guided evaluation underestimated the intervertebral level in 30% of cases. Ultrasound showed a high accuracy in detecting difficult spinal anesthesia and its use should be recommended in the daily clinical practice in order to increase success rate and minimize patient discomfort. The absence of both DM complexes at ultrasound should lead the anesthetist to evaluate other intervertebral levels or consider alternative techniques.

Utilization of point-of-care ultrasound among graduates of a 4-year longitudinal medical school ultrasound curriculum.

In 2011, School of Medicine, University of California, Irvine was among the first schools to implement a 4-year ultrasound curriculum. We aimed to find the point-of-care ultrasound (POCUS) utilization pattern among University of California, Irvine alumni. We surveyed University of California, Irvine alumni from the class of 2011 and beyond. Survey questions included POCUS reliance, frequency of use, and comfort with image acquisition and interpretation compared with peers. The primary outcomes were self-reported comfort and reliance on POCUS. We received 93 responses from 624 surveyed alumni (response rate, 14.9%), of which 87 were analyzed. Although 46 respondents (52.9%) reported more reliance on POCUS, three (3.4%) relied on it less than their peers. At the same time, 72 (82.7%) and 67 (77.0%) felt more comfortable than their colleagues in obtaining and interpreting POCUS, respectively. No respondents felt less comfortable obtaining or interpreting POCUS than their peers. The frequency of POCUS use correlated directly with the frequency with which POCUS changed the responder's case management (rho, 0.860; P<0.001). POCUS reliance also correlated with respondents' comfort level in obtaining (rho, 0.321; P<0.001) and interpreting (rho, 0.378; P<0.001) POCUS results. University of California, Irvine graduates had higher reliance on POCUS than peers in their respective specialties. Their POCUS findings frequently changed their case management.

Correlation of Intraoperative Ultrasonographic Oral Tongue Shape and Border and Risk of Close Margins

Intraoperative ultrasound (IOUS) is a potentially useful adjunct to the resection of oral tongue cancers (OTC). IOUS images of the tumor-normal tissue interface show different patterns of invasion. In this retrospective series of 29 patients treated for OTC, we evaluated if there was a correlation between IOUS findings of patterns of invasion and final histology and assessed if there was any associated risk of increased incidence of positive or close margins with different patterns of invasion as seen on ultrasound. Although we found no significant correlation between ultrasound patterns of invasion and histological evaluation, we did find that an infiltrative pattern of invasion on IOUS did result in a significant risk of a close margin. Further exploration of these findings in a larger prospective study could provide definitive information on the efficacy of this modality in OTC resections.

Large ciliary body melanocytoma with pseudocysts: a case report

BackgroundTo describe the correlation between standardized A-scan echography and histopathology in a ciliary body melanocytoma.Case presentationWe present a case of a large ciliary body melanocytoma with significant growth, vision loss, and elevated intraocular pressure that was diagnosed clinically as a melanoma, but the standardized A-scan findings correlated to the histopathological description of a melanocytoma with multiple pseudocysts.ConclusionsThe reflectivity of this melanocytoma by standardized A-scan was consistent with multiple pseudocysts on pathological evaluation. This echographic pattern guided the differential diagnosis. Standardized A-scan is an important diagnostic tool in the differentiation of ciliary body melanocytomas from melanomas.

Inflammatory Pseudotumor of the Omentum in Contrast-enhanced Ultrasound.

Inflammatory pseudotumor is a rare benign tumor that can occur at various body sites. Due to its rare occurrence and histological variety radiological data is heterogeneous and limited. We present a case of a 71-year-old man with inflammatory pseudotumor of the omentum. Contrast-enhanced ultrasound perfusion pattern showed homogeneous, isoechoic enhancement in the arterial phase with a washout phenomenon in the parenchymal phase, mimicking a peritoneal carcinomatosis. Inflammatory pseudotumor represents a rare, but important benign differential diagnostic option when considering a malignant disorder. Contrast-enhanced ultrasound is helpful in identifying vital tissue for a targeted biopsy for subsequent histological examination that is essential for the exclusion of malignancy.

Possibilities of using instrumental diagnostic methods for dynamic monitoring of patients with COVID-19-associated lung disease

Objective. Тo evaluate the possibility of using instrumental methods (spirometry and ultrasound diagnostics) for dynamic monitoring of patients with COVID-19-associated lung disease.Materials and methods. To achieve this goal, we performed a comprehensive instrumental diagnosis of respiratory system lesions in 58 patients (age - 56.0 years [31; 65]) with confirmed COVID-19, followed by examination of indexes of external respiratory function and ultrasound pattern in the dynamics.Results. In the process of dynamic observation, there was a parallelism of changes in the indexes of external respiratory function and changes revealed by lung ultrasound in patients with COVID-19.Conclusion.Combination of such methods of lung condition examination as spirometry and ultrasound diagnostics allows effective dynamic monitoring of COVID-19 patients without use of imaging methods associated with radiation exposure.

Ultrasound contrast-enhanced patterns of sentinel lymph nodes: predictive value for nodal status and metastatic burden in early breast cancer

In the post-Z0011 era, sentinel lymph node (SLN) status and metastatic burden determine whether axillary management entails conservative sentinel lymph node biopsy (SLNB) or radical axillary lymph node dissection (ALND) in breast cancer patients. However, SLN status and metastatic burden cannot be evaluated preoperatively in clinical practice. This study explored the predictive value of contrast-enhanced ultrasound (CEUS) patterns of SLN to assess the nodal status and metastatic burden in early breast cancer patients. A retrospective study was conducted on 88 consecutive patients who were diagnosed with clinical T1-2N0 breast cancer between December 2020 and November 2021 at the Lanzhou University Second Hospital and scheduled for SLNB. Preoperative CEUS was performed to confirm the location and enhancement pattern of the SLN, and the conventional ultrasonic characteristics of the primary breast lesions and SLN were recorded. Intraoperative localized SLN and postoperative pathological results were used as the gold standard for comparison with preoperative ultrasound findings. CEUS successfully identified at least 1 SLN in 88 patients, with a total of 118 SLNs identified in the entire cohort. Univariate analysis showed that lesion size, blood flow grade, SLN longitudinal diameter, cortical thickness, and enhancement pattern were significant predictive features of SLN metastasis. Further multiple regression analysis indicated that the enhancement pattern of the SLN was an independent risk factor for SLN metastasis, with a sensitivity and a specificity of 84.2% (32/38) and 80.0% (40/50), respectively. Meanwhile, the SLN enhancement pattern could predict the lymph node metastasis burden (P<0.001). In patients presenting with a type I (homogeneous enhancement) or type II (heterogeneous enhancement) SLN, 91.5% (65/71) had ≤2 positive SLNs, whereas in patients with a type III (no enhancement) SLN, 70.6% (12/17) had >2 metastatic nodes. The contrast-enhanced pattern of the SLN is an independent risk factor for SLN status. Patients presenting with a type I or type II SLN enhanced pattern are unlikely to have high-burden metastases detected at their final surgical treatment and omission of ALND may be appropriate.

Трехмерная эхография в оценке морфофункционального состояния эндометрия у пациенток после односторонней аднексэктомии

Objective. To study the morphological and functional characteristics of the endometrium in patients of reproductive age before and after unilateral adnexectomy using a three-dimensional (3D) ultrasound imaging. Patients and methods. A total of 113 patients after unilateral adnexectomy were examined. The mean age of patients was 32.85 ± 4.01 years. Two patient groups were identified: group 1 (n = 51) consisted of patients with mature teratomas; group 2 (n = 62) included patients who underwent surgery for epithelial ovarian tumors (endometrioid (30; 48.4%), serous (21; 33.9%), and mucinous (11; 17.7%) cystadenomas). The 3D ultrasound examination of pelvic organs was performed in the middle luteal phase of the menstrual cycle before surgery and at 6, 12 months after it. The endometrial thickness, volume, and ultrasound pattern were studied, as well as volumetric vascularity indices: vascularization index (VI), flow index (FI), and the vascularizationflow index (VFI). Based on the ESHRE consensus (2022), the ovarian reserve was assessed. Results. The improvement of endometrial perfusion was noted at 12 months after surgery. In patients with ovarian teratomas, compensatory restoration of morphological and functional properties of the ovary and endometrium was recorded. The opposite pattern was observed in the group of patients with epithelial tumors. Thus, patients operated on for ovarian endometriomas had an extremely thin endometrium (3.5 ± 0.1 mm), whose values were 1.5 times lower compared to those of patients with serous and mucinous cystadenomas; the glandular layer volume was expectedly low (1.1 ± 0.9 cm3). Conclusion. The minimum effective restoration period for the collateral ovary after unilateral adnexectomy is at least 6 months. The qualitative and quantitative parameters of 3D Doppler velocimetry can be used as predictors of the endometrial morphological and functional state in patients of reproductive age. Key words: 3D ultrasound, mature teratomas, cystadenomas, endometrium, endometrioid cysts, VOCAL

Utility of lung ultrasound in adjustment of the initial mechanical ventilation settings in patients with acute respiratory distress syndrome

Background Bedside lung ultrasound (US) is an essential tool in assessing lung aeration in severely ill patients. Aim The goal of this study was to determine the use of lung US in evaluating changes in lung aeration in dependent lung areas during positive end expiratory pressure (PEEP) titration in patients with acute respiratory distress syndrome (ARDS). Patients and methods A total of 52 mechanically ventilated patients with ARDS admitted in the ICU of Abbassia Chest Hospital were enrolled in this study. Transthoracic sonography was performed at the posterior axillary line on either side after 30 min of initial ventilator settings; recruitment at the end of expiration was sonographically assessed while changing PEEP. Arterial blood gases were performed before and after recruitment maneuver along with continuous monitoring of hemodynamics and oxygen saturation throughout the procedure. The procedure was terminated if the plateau pressure exceeded 30 cmH2O or if there was hemodynamic compromise. Results A total of 52 mechanically ventilated patients with ARDS were enrolled in the study. Overall, 80% had severe ARDS. Initial US assessments were done, and subpleural consolidation (C) was found in 18 patients, whereas exaggerated B lines (B) were found in 33 patients. After PEEP titration, under US guidance, 13 patients changed the US pattern from C to B and 22 patients changed from B to A (A-line pattern). These results correlated with improvement of PaO2/FiO2 ratio from 69.98 ± 27.93 to 86.21 ± 31.64 and increased compliance from 26.49 ± 8.63 to 28.73 ± 8.74. However, there was an increase in plateau pressure from 25.12 ± 3.88 to 27.98 ± 3.18, and also PaCO2 increased from 51.00 ± 16.05 to 58.52 ± 15.93. The mean arterial blood pressure decreased from 84.87 ± 7.91 to 81.60 ± 8.72. Conclusion US is an effective tool in achieving PEEP titration in mechanically ventilated patients with ARDS. US finding of aeration correlates well with improvement in oxygenation and compliance. However, the patients should be monitored for safe limits of pressures, hemodynamics, and PaCO2 level that may rise.

How Could One Sperm and One Oocyte Proceed To Molar Pregnancy? Prevalence of Molar Pregnancy during ICSI Procedure in Over 25,000 Fresh Embryo Transfers: A Retrospective Cross-Sectional Study.

Gestational trophoblastic disease (GTD) is a heterogeneous group of diseases characterized by excessive proliferating trophoblastic tissue. The prevalence of GTD has a varied geographical distribution. However, its frequency following intracytoplasmic sperm injection (ICSI) cycles has not yet been reported. This study aimed to estimate GTD frequency and prevalence after ICSI cycles. This retrospective cross-sectional study included all patients diagnosed with GTD subsequent to ICSI and segmental embryo transfer procedure during 2011-2019 at Royan Institute. GTD diagnosis was established for patients who met all three criteria: beta-human chorionic gonadotropin (β-hCG) levels greater than 100,000 mIU/mL, vesicular ultrasonographic pattern, and presence of pathologic features of hydatidiform mole. Although we assessed the GTD frequency in all ICSI cycles, GTD cases were only observed following fresh embryo transfer ICSI procedures. We evaluated 25,667 fresh embryo transfer ICSI procedures out of 41,540 ICSI cycles. This study identified a total of 10 GTDs confirmed by all criteria which were mentioned previously. Of these 10 GTDs, nine cases had hydatidiform mole, and one had gestational trophoblastic neoplasia. The frequency of GTD was calculated 10 cases in 41,540 (0.240 per 1000) ICSI procedures and 10 in 25,667 (0.389 per 1000) fresh embryo transfers following ICSI cycles. Also, we detected 10 GTD cases in 8,196 (1.220 per 1000) clinical pregnancies. We discuss that the possibility of GTD after ICSI procedure is not as low as expected. Thus, the previous theses are insufficient to explain all aspects of molar pregnancy, and more research is required.

Ultrasonographic patterns of different regions of uterus according to pregnancy in cows and heifers.

This study aimed to detect pregnancy within the first 20 days after artificial insemination by evaluating the ultrasonographic patterns of the different regions of uterus in Holstein heifers and cows. Animals were divided into subgroups according to pregnancy on 28th day as pregnant (heifer, n: 15; cow, n: 15) and non-pregnant (heifer, n: 15; cow, n: 15). Images were taken from the ovulation-side cornu uteri (OSC), non-ovulation-side cornu uteri (NOSC), and the corpus uteri (CU) on alternate days from D0 to D20. The images were evaluated by ImageJ software in terms of mean gray value (MGV), homogeneity (HOM), and contrast (CON) and endometrium thickness (ET). The mean MGV and G*T and P*T interactions, the mean CON and G*T and G*P interactions, the mean HOM and G*P interactions, and the mean ET and G*P interactions were statistically significant (p < 0.05). In receiver operating characteristic analyses, D2-D6 for CON and D2, D6, D8, D16, and D20 for HOM of OSC in cows and D8 and D10 MGV and D18 and D20 ET of OSC in heifers had high relationship with positive pregnancy (p < 0.05). The use of echogenicity evaluations and endometrium thickness measurements in reproductive management seems to be suitable for the prediction of pregnancy in cows and heifers.

CHARACTERISTICS OF NON-RENAL NORMOCALCIEMIC HYPERPARATHYROIDISM IN THE CHORNOBYL NPP ACCIDENT SURVIVORS.

to assess the hormonal and metabolic disorders in the Chernobyl nuclear power plant (ChNPP) accident survivors (AS), having got secondary normocalcemic non-renal hyperparathyroidism (HPT) in the late period upon exposure to ionizing radiation (IR). The routine clinical, anthropometric, instrumental (thyroid and parathyroid diagnosticultrasound), laboratory (biochemical, hormonal), statistical methods were applied. In both prospective (n = 48, control group n = 19) and retrospective studies the data of 2,234 subjects including 1,372 irradiated adults (862 non-irradiated persons in the control group) were evaluated. Clinical consequences of exposure to IR on the endocrine system were evaluated in ChNPP AS. High prevalence of vitamin D lack or deficiency was established retrospectively in 81.8 % of the ChNPP AS and in 89.5 % of the control group subjects. In general, there was neither effect of exposure to IR on the vitamin D status in study subjects, nor any difference between the study groups. According to diagnostic ultrasound patterns the parathyroid hyperplasia was diagnosed in 629 cases (28.2 %). Among the ChNPP AS it was found in 32.7 % of cases (n = 450) vs. 20.7 % (p > 0.005) in the control group (a 1.6-fold difference). HPT diagnosed as serum parathyroid hormone content > 65 ng/ml was diagnosed in 123 cases (21.1 %) i.e. in almost every fifth person. Increased serum level of parathyroid hormone was found in the 94 ChNPP AS and in 25 persons of the comparison group. In other words, the frequency of HPT was 23.7 % among the AS being significantly more than in the comparison group (13.2 %, p < 0.005). Frequency of normocalcemic non-renal HPT was slightly different by years of observation with a trend to the year-by-year increase. High prevalence of vitamin D lack or deficiency was established in the ChNPP AS, being however independent of exposure to IR. Frequency of parathyroid hyperplasia/adenoma was 1.6 times higher in the irradiated subjects than in persons of the control group. Annual increase in frequency of the non-renal normocalcemic HPT was also revealed reaching nowadays 23.7 % among the AS, which is significantly higher than in the comparison group.

The importance of lung recruitability: A novel ultrasound pattern to guide lung recruitment in neonates.

Lung Ultrasound (LUS)-guided Lung Recruitment Maneuver (LRM) has been shown to possibly reduce ventilator-induced lung injury in preterm infants. However, to avoid potential hemodynamic and pulmonary side effects, the indication to perform the maneuver needs to be supported by early signs of lung recruitability. Recently, a new LUS pattern (S-pattern), obtained during the reopening of collapsed parenchyma, has been described. This study aims to evaluate if this novel LUS pattern is associated with a higher clinical impact of the LUS-guided LRMs. All the LUS-guided rescue LRMs performed on infants with oxygen saturation/fraction of inspired oxygen (S/F) ratio below 200, were included in this cohort study. The primary outcome was to determine if the presence of the S-pattern is associated with the success of LUS-guided recruitment, in terms of the difference between the final and initial S/F ratio (Delta S/F). We reported twenty-two LUS-guided recruitments, performed in nine patients with a median gestational age of 34 weeks, interquartile range (IQR) 28-35 weeks. The S-pattern could be obtained in 14 recruitments (64%) and appeared early during the procedure, after a median of 2 cmH2O (IQR 1-3) pressure increase. The presence of the S-pattern was significantly associated with the effectiveness of the maneuver as opposed to the cases in which the S-pattern could not be obtained (Delta S/F 110 +/- 47 vs 44 +/- 39, p = 0.01). Our results suggest that the presence of the S-pattern may be an early sign of lung recruitability, predicting LUS-guided recruitment appropriateness and efficacy.

Clinical, Sonographic, and Hysteroscopic Features of Endometrial Carcinoma Diagnosed after Hysterectomy in Patients with a Preoperative Diagnosis of Atypical Hyperplasia: A Single-Center Retrospective Study.

atypical endometrial hyperplasia (AEH) is a precancerous condition implying a high risk of concurrent endometrial cancer (EC), which might be occult and only diagnosed at postoperative histopathological examination after hysterectomy. Our study aimed to investigate potential differences in preoperative clinical, sonographic, and hysteroscopic characteristics in patients with AEH and postoperative diagnosis of EC. a retrospective single-center study was carried out on a case series of 80 women with AEH undergoing diagnostic workup, including ultrasonography and hysteroscopy, with subsequent hysterectomy. Women with AEH confirmed at the histopathological examination were compared with patients with a postoperative diagnosis of EC. in our population, EC was diagnosed in 53 women, whereas the preoperative diagnosis of AEH was confirmed in 27 cases. At ultrasonography, women with occult EC showed greater endometrial thickness (20.3 mm vs. 10.3 mm, p 0.001) and size of the endocavitary lesion (maximum diameter 25.2 mm vs. 10.6 mm, p 0.001), and a higher prevalence of irregular endometrial-myometrial junction (40.5% vs. 6.7%, p 0.022) and endouterine vascularization at color Doppler (64.2% vs. 34.6%, p 0.017). At hysteroscopy, patients with occult EC showed a higher prevalence of necrosis (44.2% vs. 4.2%, p 0.001) and atypical vessels (70.6% vs. 33.3%, p 0.003), whereas true AEH mainly presented as a protruding intracavitary lesion (77.8% vs. 50.9%, p 0.029). In EC, subjective assessment by the operator was more frequently indicative of cancer (80.0% vs. 12.5%). No difference was found for clinical variables. occult EC in AEH may exhibit some differences in ultrasonographic and hysteroscopic patterns of presentation compared with real AEH, which could prompt a more significant suspect for the possible presence of concurrent EC at preoperative diagnostic workup.

Can neurophysiology and nerve ultrasound differentiate acute-onset CIDP from GBS with treatment-related fluctuations?

Distinguishing acute-onset chronic inflammatory demyelinating polyneuropathy (A-CIDP) from Guillain- Barré syndrome (GBS) with treatment-related fluctuations (TRF) in the early phase of disease can be challenging. Although characteristic clinical features have been previously reported, there is limited data on neurophysiological features. We aim to identify the electrophysiological and ultrasonographic features that might help differentiate between these two conditions. Patients with GBS-TRF and A-CIDP were identified from an existing cohort of GBS patients presenting to University of Malaya Medical Centre, Kuala Lumpur, Malaysia from 2011 to 2020. The clinical, electrophysiological and nerve ultrasound data were recorded and analysed. Five GBS-TRF (mean age 42 ± 23 years) and five A-CIDP (mean age 66 ± 13 years) patients were included. The mean time to first neurological deterioration was longer in A-CIDP compared to GBS-TRF (11 ± 5 vs 5 ± 1 weeks, p=0.028). Based on two sets of nerve conduction studies (NCS), both GBS-TRF and A-CIDP patients fulfilled the electrodiagnostic criteria for demyelinating neuropathy. A-CIDP patients had more prolonged ulnar minimal F-wave latencies (40.8 ± 5.8 vs 28.6 ± 2.2 ms, p=0.020) and slower sural conduction velocities (26.3 ± 8.6 vs 41.4 ± 3.4 m/s, p=0.015) on NCS. Nerve ultrasound showed significantly larger cross- sectional area of ulnar nerve at the wrist (7 ± 2 vs 5 ± 1 mm2, p=0.037) and forearm (8 ± 1 vs 5 ± 1 mm2, p=0.025) in A-CIDP patients. The Ultrasound Pattern Sum Score-A was significantly higher in A-CIDP compared to GBS-TRF (10 ± 3 vs 5 ± 1, p=0.015). We found nerve electrophysiological and ultrasonographic features can be useful in differentiating between GBS-TRF and A-CIDP.