Ultrasound Scan Findings Research Articles

EP08.05: Fetal anomalies detected in Sri Lankan tertiary fetal medicine referral centre

Screening for birth defects during the second trimester has been an established practice in antenatal care. The mid-trimester scan at 18-23 weeks enables to pick both internal and external abnormalities of the developing fetus. The objective of this study was to present the pattern of fetal anomalies detected in pregnant mothers who were referred to a tertiary fetal medicine referral centre in Sri Lanka. A retrospective study was carried out in one of the largest tertiary level fetal Medicine referral centres in Sri Lanka between July 2013 and March 2017. Patient information and the ultrasound scan findings were obtained from the purpose built database at the centre. A total of 3900 referrals were reviewed and all singleton pregnancies were included to the study. The mean maternal age and the mean gestational age at which the anomaly scan was performed were 31.0 years (SD=4.8) and 22.8 weeks (SD=4.9) respectively. Of the 3900 referrals 36 (0.9%) had neural tube defects including anencephaly, meningomyelocele and spina bifida. Dandy-Walker complex was detected in 25 (0.64%) fetuses together with Dandy-Walker malformation, Dandy-Walker variant and the mega-cysterna magna. Cleft lip and palate was the commonest congenital abnormality seen in the face which accounted for 19 (0.49%) of the study group. Of the study population 171 (4.38%) fetuses had congenital heart defects and the commonest heart defect was Ventricular Septal Defect (0.56%). Seventeen (0.44%) fetuses had the Atrioventricular Septal Defect which predict the Down syndrome at the mid-trimester scan. Abdominal wall defects and bladder exstrophy were detected in 15 (0.38%) and 5 (0.12%) fetuses respectively. Thirty (0.76%) and 20 (0.51%) fetuses had Congenital talipes deformity and cystic renal disease respectively. Congenital heart defects were the most commonly detected abnormalities. Neural tube defects, congenital talipes and renal tract abnormalities were the other commonly detected abnormalities.

P183 Retrospective analysis of the utilisation of scrotal ultrasound scan in sexual health clinic

IntroductionMost scrotal/testicular symptoms and signs are benign. US Scan is investigation of choice in these patients. However, several studies have shown ultrasound scan findings rarely changes management of these patients. Our aim was to understand how ultrasound scan influenced the diagnosis and management of men with scrotal or testicular symptoms seen in our sexual health clinic.MethodsRetrospective data collected from clinical records of all men seen in sexual health clinic and referred for US scan between 2010 and 2016. Data collected include age, presenting symptoms, STI screen, clinical and ultrasound finding.166 men had ultrasound scan. 23 men excluded due to incomplete data. Data collected and analysed for 143 men.ResultsMedian age was 33 years (range 15 – 72 years). Common scrotal/testicular symptoms were: lump 72 (50%), aches/pain 45 (31.5%), others 15 (10.5%). Ultrasound scan diagnoses were: Benign epidydimal or tunica albuginea cyst 40 (28%), Varicocele 25 (17.5%), Hydrocele 15 (10.5%), Normal 34 (24%), other 26 (18%), Cancers (testicular 2 and sarcoma 1) (2%). 7 men were referred to urologist for cancer treatment and embolization of varicocele.DiscussionMost men had benign scrotal conditions or normal findings confirmed on scan. This did not change their management plan. Two cases of testicular cancers were initially suspected on clinical examination.

Is fine needle aspiration thyroid cytology (THY status) a good prognostic indicator of definitive histological diagnosis?

Although recently published research has focused on the addition of ultrasound scan findings to the evaluation of the thyroid gland, FNAC has long been the corner stone of thyroid lesion decision making. In our study population of 100 thyroidectomies we found out of those who had a cytological diagnosis of Thy 2 and underwent thyroidectomy due other compounding factors 8.57% of the had malignancy reported in their final histology report. We also found that a Right-sided solidarity thyroid nodule in a male may be an increased risk factor for malignancy. We highly recommend addition of USS staging to be included in decision making especially in benign lesions as there is still a significant risk of malignancy.

Amoebic liver abscess in northern Sri Lanka: first report of immunological and molecular confirmation of aetiology

BackgroundSince 1985, amoebic liver abscess (ALA) has been a public health problem in northern Sri Lanka. Clinicians arrive at a diagnosis based on clinical and ultrasonographic findings, which cannot differentiate pyogenic liver abscess (PLA) from ALA. As the treatment and outcome of the ALA and PLA differs, determining the etiological agent is crucial.MethodsAll clinically diagnosed ALA patients admitted to the Teaching Hospital (TH) in Jaffna during the study period were included and the clinical features, haematological parameters, and ultrasound scanning findings were obtained. Aspirated pus, blood, and faecal samples from patients were also collected. Pus and faeces were examined microscopically for amoebae. Pus was cultured in Robinson’s medium for amoebae, and MacConkey and blood agar for bacterial growth. ELISA kits were used for immunodiagnosis of Entamoeba histolytica infection. DNA was extracted from selected pus samples and amplified using nested PCR and the purified product was sequenced.ResultsFrom July 2012 to July 2015, 346 of 367 clinically diagnosed ALA patients admitted to Jaffna Teaching Hospital were enrolled in this study. Almost all patients (98.6%) were males with a history of heavy alcohol consumption (100%). The main clinical features were fever (100%), right hypochodric pain (100%), tender hepatomegaly (90%) and intercostal tenderness (60%). Most patients had leukocytosis (86.7%), elevated ESR (85.8%) and elevated alkaline phosphatase (72.3%). Most of the abscesses were in the right lobe (85.3%) and solitary (76.3%) in nature. Among the 221 (63.87%) drained abscesses, 93.2% were chocolate brown in colour with the mean volume of 41.22 ± 1.16 ml. Only four pus samples (2%) were positive for amoeba by culture and the rest of the pus and faecal samples were negative microscopically and by culture. Furthermore, all pus samples were negative for bacterial growth. Antibody against E. histolytica (99.7%) and the E. histolytica antigen were detected in the pus samples (100%). Moreover, PCR and sequencing confirmed these results.ConclusionTo our knowledge, this is the first report from Sri Lanka that provides immunological and molecular confirmation that Entamoeba histolytica is a common cause of liver abscesses in the region.

Effects of intrauterine retention and postmortem interval on body weight following intrauterine death: implications for assessment of fetal growth restriction at autopsy.

According to the classification system used, 15-60% of stillbirths remain unexplained, despite undergoing recommended autopsy examination, with variable attribution of fetal growth restriction (FGR) as a cause of death. Distinguishing small-for-gestational age (SGA) from pathological FGR is a challenge at postmortem examination. This study uses data from a large, well-characterized series of intrauterine death autopsies to investigate the effects of secondary changes such as fetal maceration, intrauterine retention and postmortem interval on body weight. Autopsy findings from intrauterine death investigations (2005-2013 inclusive, from Great Ormond Street Hospital and St George's Hospital, London) were collated into a research database. Growth charts published by the World Health Organization were used to determine normal expected weight centiles for fetuses born ≥ 24 weeks' gestation, and the effects of intrauterine retention (maceration) and postmortem interval were calculated. There were 1064 intrauterine deaths, including 533 stillbirths ≥ 24 weeks' gestation with a recorded birth weight. Of these, 192 (36%) had an unadjusted birth weight below the 10th centile and were defined as SGA. The majority (86%) of stillborn SGA fetuses demonstrated some degree of maceration, indicating a significant period of intrauterine retention after death. A significantly greater proportion of macerated fetuses were present in the SGA population compared with the non-SGA population (P = 0.01). There was a significant relationship between increasing intrauterine retention interval and both more severe maceration and reduction in birth weight (P < 0.0001 for both), with an average artifactual reduction in birth weight of around -0.8 SD of expected weight. There was an average 12% reduction in fetal weight between delivery and autopsy and, as postmortem interval increased, fetal weight loss increased (P = 0.0001). Based on birth weight alone, 36% of stillbirths are classified as SGA. However, fetuses lose weight in utero with increasing intrauterine retention and continue to lose weight between delivery and autopsy, resulting in erroneous overestimation of FGR. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Which intervention reduces the risk of preterm birth in women with risk factors?

#### What you need to know The aim of preventing preterm birth is to improve the health of babies by prolonging pregnancy. Preterm birth, or delivery before 37 weeks’ gestation, affects 7.3% of pregnancies in the UK.1 Around 75% of these births result from spontaneous preterm labour. The remaining 25% are delivered for medical reasons and are not considered further in this article. Box 1 lists clinical risk factors and ultrasound scan findings that are associated with an increased risk of spontaneous preterm birth. However, these factors have poor predictive value. Women with multiple pregnancy are also at high risk of preterm birth, and their management is discussed in the supplementary online material. #### Box 1: Risk factors for preterm birth234 ##### Clinical history* ##### Imaging Three treatment interventions are available to women at risk of spontaneous preterm birth (fig 1⇓). Considerable uncertainty exists over the effectiveness of these interventions, however, in part because clinical trials are hard to perform. Large numbers of trial participants are needed because most women at high risk of spontaneous preterm birth deliver at term, even without treatment. It is difficult and expensive to include neonatal and childhood …

Malignant Middle Cerebral Artery Infarction Secondary to Traumatic Bilateral Internal Carotid Artery Dissection. A Case Report

Traumatic bilateral dissection of the carotid arteries is a rare condition with potentially life-threatening complications. The case of a 57-year-old male patient with acute onset left sided hemiparesis, twelve hours after a blunt head injury, caused by a horse kick, is reported. A cerebral CT scan revealed right middle cerebral artery (MCA) territory infarction. Based on Duplex ultrasound and Angio CT scan findings, a diagnosis of bilateral ICA dissection was established. Despite antithrombotic treatment, the patient presented with a progressive worsening of his neurological status. The control CT scan evidenced malignant right MCA territory infarction that required decompressive craniotomy. The patient was discharged with significant neurological deficits. Together with this case, the aetiologies, clinical manifestations, diagnostic and therapeutical options and outcome of carotid artery dissection are discussed.

Neurodevelopmental Outcomes in Preterm Infants with Intraventricular Hemorrhage in Canada

Abstract BACKGROUND: Conflicting evidence exists in regards to outcomes of infants with mild IVH [subependymal hemorrhage (SEH) and IVH without ventricular dilatation (VD)] with recent reports suggesting poor outcomes. OBJECTIVES: To compare 1) neurodevelopmental (ND) outcomes of infants &amp;lt; 29 wks GA with normal head ultrasound scan findings (Group 1: no IVH/PVL/VD to those with a) Group 2: SEH or IVH without VD, b) Group 3: IVH with VD (ventricle size &amp;gt; 10 mm) and c) Group 4: persistent intraparenchymal echogenicity (IPE) or lucency with or without IVH and 2) composite outcome of death or ND impairment (NDI)/severe NDI (SNDI) at 18-24 months in these groups. DESIGN/METHODS: Retrospective cohort study of data from Canadian Neonatal Network (CNN)and Canadian Neonatal Follow-up Network (CNFUN) from April 2010 to September 2011. NDI was defined as any one of Bayley III score &amp;lt; 85 (cognition, language or motor), cerebral palsy (CP) or visual/hearing impairment. SNDI was defined as Bayley III score &amp;lt; 70 for any of the 3 components, CP with GMFCS &amp;gt; 3, severe visual impairment &amp;lt;20/200 or hearing impairment needing aids/cochlear implants. Data for the 4 groups were compared using Chi-squared test or ANOVA as appropriate. Multivariable regression was conducted to obtain adusted OR (95% CI). RESULTS: See tables on page e51. CONCLUSION: In this large national cohort, infants with SEH and/or IVH without VD had similar outcomes to infants with no IVH. The risk of death or adverse ND outcome was significantly higher ininfants with IVH with VD and those with IPE.

MP55-01 CONTEMPORARY PRACTICE PATTERNS IN VOIDING CYSTOURETHROGRAM (VCUG) USE: THE IMPACT OF EVIDENCE-BASED GUIDELINES

You have accessJournal of UrologyPediatrics: Urinary Tract Infection and Vesicoureteral Reflux1 Apr 2016MP55-01 CONTEMPORARY PRACTICE PATTERNS IN VOIDING CYSTOURETHROGRAM (VCUG) USE: THE IMPACT OF EVIDENCE-BASED GUIDELINES Linda Lee, Armando Lorenzo, Rakan Odeh, Paul Bowlin, Jeffrey Traubici, and Martin Koyle Linda LeeLinda Lee More articles by this author , Armando LorenzoArmando Lorenzo More articles by this author , Rakan OdehRakan Odeh More articles by this author , Paul BowlinPaul Bowlin More articles by this author , Jeffrey TraubiciJeffrey Traubici More articles by this author , and Martin KoyleMartin Koyle More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.592AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES While VCUG is a widely accepted test, it is invasive and associated with radiation exposure. Most cases of VUR are low-grade and unlikely to be associated with acquired renal scarring. In an effort to select patients at greatest risk, the American Academy of Pediatrics (AAP) published revised guidelines on urinary tract infections in children ages 2 to 24 months in 2011. In this project, we examine contemporary practice patterns and indications for VCUG, in the context of newer evidence-based guidelines. We hypothesize that the rate of VCUGs has declined over time, which may be geared towards detection of more clinically significant VUR. METHODS All VCUGs performed at our institution from 2008 to present were identified. Follow-up VCUGs were excluded. Further data collection was performed for patients whom had a VCUG in the first six months of 2009 and 2014, in order to obtain representative data before and after publication of the 2011 AAP guidelines. Medical records for these patients were retrospectively reviewed for baseline patient characteristics, indication for VCUG, type of ordering physician, prior history of febrile UTIs, renal and bladder ultrasound and renal scan findings. RESULTS From January 2008 to August 2014, a total of 8214 VCUGs were performed at our institution. The annual number of VCUGs has declined steadily over time. We then compared the 6-month periods from January to June (inclusive) in 2009 and 2014, which identified 634 and 292 VCUGs, respectively. There were no statistically significant differences in mean age or gender between both groups. Although there was a decline in VCUGs in 2014, the rate of VCUGs performed for UTIs remained the same (65% in 2009 and 64% in 2014, p=0.88). In both groups, pediatric urologists comprised the minority of ordering physicians (14% in 2009 and 16% in 2014, p=0.48). While there is no statistically significant difference in detection rate of VUR from 2009 to 2014 (31% vs. 37%, p=0.07), there has been a three-fold increase in diagnosis of high grade (IV-V) VUR in 2014, compared to 2009 (10.2% vs 3.2%, p=0.0001). CONCLUSIONS There has been an overall trend towards fewer VCUGS being performed at our institution, even prior to the 2011 AAP guidelines. While the majority of VUR cases detected remain low-grade, there has been a higher detection rate of high-grade (IV-V) VUR in 2014, compared to 2009. This may be a reflection of changing practice patterns of ordering physicians. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e735 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Linda Lee More articles by this author Armando Lorenzo More articles by this author Rakan Odeh More articles by this author Paul Bowlin More articles by this author Jeffrey Traubici More articles by this author Martin Koyle More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Genetic spectrum of Saudi Arabian patients with antenatal cystic kidney disease and ciliopathy phenotypes using a targeted renal gene panel

BackgroundInherited cystic kidney disorders are a common cause of end-stage renal disease. Over 50 ciliopathy genes, which encode proteins that influence the structure and function of the primary cilia, are...

New scoring system for intra-abdominal injury diagnosis after blunt trauma

ObjectiveAn accurate scoring system for intra-abdominal injury (IAI) based on clinical manifestation and examination may decrease unnecessary CT scans, save time, and reduce healthcare cost. This study is designed to provide a new scoring system for a better diagnosis of IAI after blunt trauma. MethodsThis prospective observational study was performed from April 2011 to October 2012 on patients aged above 18years and suspected with blunt abdominal trauma (BAT) admitted to the emergency department (ED) of Imam Hussein Hospital and Shohadaye Hafte Tir Hospital. All patients were assessed and treated based on Advanced Trauma Life Support and ED protocol. Diagnosis was done according to CT scan findings, which was considered as the gold standard. Data were gathered based on patient’s history, physical exam, ultrasound and CT scan findings by a general practitioner who was not blind to this study. Chisquare test and logistic regression were done. Factors with significant relationship with CT scan were imported in multivariate regression models, where a coefficient (β) was given based on the contribution of each of them. Scoring system was developed based on the obtained total β of each factor. ResultsAltogether 261 patients (80.1% male) were enrolled (48 cases of IAI). A 24-point blunt abdominal trauma scoring system (BATSS) was developed. Patients were divided into three groups including low (score<8), moderate (8≤score<12) and high risk (score≥12). In high risk group immediate laparotomy should be done, moderate group needs further assessments, and low risk group should be kept under observation. Low risk patients did not show positive CT-scans (specificity 100%). Conversely, all high risk patients had positive CT-scan findings (sensitivity 100%). The receiver operating characteristic curve indicated a close relationship between the results of CT scan and BATSS (sensitivity=99.3%). ConclusionThe present scoring system furnishes a high precision and reproducible diagnostic tool for BAT detection and has the potential to reduce unnecessary CT scan and cut unnecessary costs.

Prenatal findings in cardio-facio-cutaneous syndrome.

Our study was designed to analyze prenatal manifestations in patients affected with cardio-facio-cutaneous syndrome (CFCS), in order to define indications of DNA testing in utero. Prenatal features were extracted from a national database and additional data were collected from 16 families contacted through the French association of CFC-Costello syndrome. We collected results of ultrasound scan (USS) biometrics, presence of congenital birth defects, and polyhydramnios. From the database, increased nuchal translucency was present in 13% of pregnancies, polyhydramnios in 52%, macrosomia and/or macrocephaly in 16%. Of the 16 pregnancies, 81% were complicated by abnormal USS findings. Polyhydramnios was reported in 67%. Head circumference, biparietal diameter, and abdominal circumference were above the 90th centile in 72%, 83% and, 81% of fetuses, respectively. Contrasting with macrosomia, femur length was below the 10th centile in 38%. Urinary tract abnormalities were found in 47% of fetuses. Most CFCS fetuses showed a combination of macrocephaly, macrosomia, and polyhydramnios, contrasting with relatively short femora. This growth pattern is also seen in Costello syndrome. We suggest that screening for CFCS and Costello gene mutations could be proposed in pregnancies showing this unusual pattern of growth parameters.

A Retrospective Descriptive Comparison Study of Transvaginal Ultrasound Scan Findings With Histology Findings on Postmenopausal Women Who Underwent Hysteroscopy for Endometrial Assessment.

A Retrospective Descriptive Comparison Study of Transvaginal Ultrasound Scan Findings With Histology Findings on Postmenopausal Women Who Underwent Hysteroscopy for Endometrial Assessment.

English

INTRODUCTION: Perinatal death rate is declining in developed and developing countries and so are perinatal autopsies. In the present days due to wider availability and awareness of prenatal scanning more and more congenital malformations are picked up in earlier weeks of gestation. This helps in counselling of the couple which usually leads to an informed decision on medical termination of pregnancy. Autopsy performed on such fetuses, yields additional information in many cases. AIMS: The study was carried out to determine how well the prenatal ultrasound findings correlate with autopsy findings and also to determine the cause of death where ultrasound was not performed in patients who had spontaneous intrauterine death and abortion. MATERIALS AND METHODS: This was a prospective study carried out over a period of two years in the department of pathology at Kamineni Academy of Medical Sciences and Research Centre, Hyderabad, from January 2013 to December 2014. A total of 23 fetal autopsies were performed of which one was a twin pregnancy. Brief maternal history, prenatal ultrasound scans, relevant biochemical markers and genetic studies wherever done, were noted. RESULTS: There were 14 male (60.86%) and 8 female (34.78%) fetuses, and in one case (4.34%) gender could not be identified. Nineteen cases (82.60 %) were less than 28 weeks of gestation. Medical termination of pregnancy was done in 13 cases (56.52 %) whereas, 10 patients (43.47 %) had spontaneous intrauterine death of the fetus. Ultrasound scanning was done in 15 cases (65.21 %). In 13 cases (86.66 %) the ultrasound and autopsy findings were correlating whereas in two cases (13.33 %) there were findings on imaging study which could not be identified on autopsy. Ultrasound was not done in 8 cases (34.78 %) out of which 5 cases (62.5 %) showed findings on autopsy which could have led to the fetal demise. Twelve cases (52.17 %) were referral cases which had come from other hospitals. Genetic studies were done in 6 cases (26.08 %) in the form of parental karyotyping and cord blood could be tested in only one case. CONCLUSIONS: There is a good correlation between prenatal ultrasound scanning and autopsy findings. However, functional heart defects, and minute ventricular septal defects cannot be identified on autopsy due to the small size of the organs. At the same time autopsy can demonstrate more accurately congenital malformations and unsuspected cord abnormalities. More awareness is required on the part of treating clinicians as to the appropriate sample collection, its timely transport to the laboratory in order to facilitate genetic testing.

Brucellosis of Testis and Epididymis: A Review of the Literature

Background: Brucellosis is a zoonotic disease which can afflict a number of organs and tissues. Brucellosis epididymo-orchitis (BEO), a complication of human brucellosis, can lead to other complications. In brucellosis non-endemic areas, some clinicians may be unfamiliar regarding the disease entity which may lead to delay in the diagnosis. Aims: To review the literature on BEO, in order to document its presentation, diagnosis, management and outcome following treatment. Methods: Various internet data bases were used to obtain literature on BEO. Results/Literature Review: BEO (epididymitis plus or minus orchitis) is a complication of brucella species which can be transmitted by direct contact through the respiratory tract, skin, or conjunctiva, and through the gastrointestinal tract after ingestion of unpasteurized milk/milk products or raw infected meat. BEO may in endemic areas affect 2 to 20% of patients with brucellosis but the disease can also be encountered sporadically globally in non-endemic areas. BEO may at times be bilateral. The presentation of BEO is non-specific and it may be mistaken for non-specific epididymo-orchitis or epididymitis or testicular tumour or abscess. Ultrasound and MRI scan findings are not specific to BEO. Diagnosis of BEO may be established by (a) history of Review Article Venyo; BJMMR, 10(2): 1-19, 2015; Article no.BJMMR.17310 2 contact, (b) cultures from blood/epididymal aspirations, (c) various types of laboratory studies including (I) Culture, (II) Polymerase chain reaction (PCR), and (III) serology. Laboratory criteria for the diagnosis of Brucellosis is divided into (I) those for presumptive diagnosis and (II) those for confirmatory diagnosis: BEO can be effectively treated by means of combination chemotherapy for about six weeks but at times ochidectomy or drainage of testicular collection may be required for persistence of symptoms or suspicion of a tumour/testicular abscess. Relapses can occur therefore careful follow-up is required. Conclusions: BEO can occur anywhere globally. A high index of suspicion is required from clinicians in order to establish early diagnosis. Most cases of BEO can be effectively treated with combination chemotherapy for about 6 weeks and triple antibiotic therapy would appear to be most effective and associated with absence or reduction of relapse.

Clinicopathological features of invasive micropapillary carcinoma of the breast.

The aim of the present study was to evaluate the clinical and immunohistopathological findings of invasive micropapillary carcinoma (IMPC) of the breast. In total, 25 patients were included in the present study, all of whom were diagnosed with IMPC. The mammography and ultrasound scanning (US) findings were analysed retrospectively according to the American College of Radiology Breast Imaging Reporting and Data System lexicon. Surgical specimens obtained from the patients were microscopically reviewed in consensus by two pathologists with a specialisation in breast pathology. All the patients presented with palpable lumps in the breast, a high-density irregular mass associated with microcalcifications revealed by mammography and an irregular hypoechoic mass with a spiculated margin revealed by US. Axillary lymph node metastases were identified in 80% of the patients. Immunohistochemical studies revealed the lesions to be highly positive for the oestrogen receptor (ER) and c-erbB-2 (88% and 84%, respectively). Although no significant imaging characteristics were found to distinguish IMPC from typical invasive ductal carcinoma, IMPC resulted in nodal metastases and was highly positive for ER and c-erbB-2. This clinical significance indicates the significance of this entity being recognised by pathologists and surgeons.

Ultrasonography as a prognostic and objective parameter in Achilles tendinopathy: A prospective observational study

ObjectivesTo study prospectively whether structural changes determined by ultrasound scanning (US) can be used as prognostic markers for outcome in patients with symptomatic Achilles tendinopathy (AT) and to investigate whether there exists an association between US findings and pain measured by visual analog scale (VAS) and a general assessment score (GA). Methods92 consecutive patients with AT symptoms were recruited from two outpatient clinics in rheumatology. The patients underwent a conservative treatment protocol consisting of reduced activities, controlled rehabilitation including eccentric exercises of the calf muscles and if needed supplemented with corticosteroid injections. The patients were examined clinically and by US (tendon thickness, hyper- and hypoechogenicity, calcification, bursitis, calcaneusspure, tenosynovitis, gray scale and color Doppler focusing on increased flow intra- or peritendinous). The clinical and US examination were performed at entry, 1, 2, 3 and at 6 month. Results42 women and 50 men were included (mean age of 47 years). They had symptoms for more than 13 months and a symptomatic Achilles tendon mean thickness of 7.4±2.3mm. Heterogeneity at the initial examination was found to be a prognostic marker for the clinical outcome. Tendon thickness, hypoechogenicity and increased flow at any time point were significantly correlated to pain at function, palpatory pain and morning pain at the same time points. A reduction in tendon thickness was statistically associated with a decrease in palpatory pain. ConclusionHeterogeneity is a prognostic marker in AT. Tendon thickness, hypoechogenicity and increased Doppler activity can be used as objective outcome parameters for the treatment effect of AT.

Commentary on 'Performance of ultrasound as a second line test to serum CA125 in ovarian cancer screening'.

Commentary on 'Performance of ultrasound as a second line test to serum CA125 in ovarian cancer screening'.

Clinical presentations of patients from different age cohorts with biliary tract stone diseases

The role of clinical symptoms, transabdominal ultrasound scan (USS), and liver function tests (LFTs) in evaluating common bile duct (CBD) stones in patients suspected to have pancreatobiliary disease has been studied. However, it is unclear whether these predictive models are useful in different age cohorts. The aim of this study is to investigate the clinical presentations from different age cohorts with and without CBD stones. Four hundred and forty-three patients with pancreatobiliary diseases were divided into cohorts according to decades as follows: young (Y, 18-64 years old, n = 143), young-old (YO, 65-74 years old, n = 168), old-old (OO, 75-84 years old, n = 97), and very old (VO, ≥ 85 years old, n = 35). The clinical symptoms, LFTs, and USS findings were demonstrated and compared among patients. Y- and YO-group patients were more likely to develop symptoms such as biliary colic in the presence of CBD stones. The proportion of abnormal serum aspartate aminotransferase and alanine aminotransferase were significantly greater in Y-, YO-, and OO-group patients with than in those without CBD stones. Sensitivity of USS for CBD stones in Y: 0.15; YO: 0.45; OO: 0.57; and VO: 0.68. Accuracy of USS for detected CBD stone in Y: 48%; YO: 62.5%; OO: 70.1%; and VO: 71.4%. Combined evaluation of clinical symptoms, biochemical and USS findings may help predict the presence of CBD stones. In Y, YO, and OO patients with CBD stones, the incidences of abnormal LFTs were higher. The sensitivity and accuracy of USS in detecting CBD stones were increased according to age.

Isolated Fallopian-Tube Torsion: A Case Series

Abstract Background: Isolated Fallopian-tube torsion is a rare event, with a reported incidence of 1:1500000. This is a single center report of 4 cases of isolated Fallopian tube torsion presenting at our single center from 2010 to 2012. Cases: All 4 cases were women presenting with right- sided lower abdominal pain. Three of the women were in their early 20s, whereas 1 woman was in her early 50s. Results: Ultrasound scan findings were nonspecific and variable, for example, ovarian cyst with echogenic focus, or normal adnexa with free fluid in the pouch of Douglas. One of the cases was a suspected heterotopic pregnancy. Laparoscopy in all these cases revealed isolated Fallopian-tube torsion. In 3 cases, salpingectomy was performed. In 1 case, tube-conserving surgery was performed to untangle the tube. All of the women recovered well after surgery. Conclusions: The incidence appears to be higher than as reported. The cause of Fallopian-tube torsion is unknown. It can be associated with an ovarian or paraov...