Ultrasound Scan Examination Research Articles

Luteal phase transvaginal scan examinations have better diagnostic potential for showing focal subendometrial adenomyosis

The objective of this preliminary observational study was to monitor changes in focal cystic and non-cystic subendometrial lesions reminiscent of adenomyosis seen during the luteal phase of the cycle by repeating transvaginal ultrasound scan examinations during the follicular phase. Five patients who presented with abnormal uterine bleeding with or without dysmenorrhoea showed such lesions, following luteal phase transvaginal scanning. All lesions became smaller and less conspicuous, or an indiscriminate endometrial/myometrial interface was seen in the suspected areas during the follicular phase. Midcycle scanning of one patient showed enhancement of the irregular subendometrial area, but still without reaching the same size, or attaining an echogenic pattern as seen during the initial luteal phase examination. We hypothesise that luteal phase transvaginal scan examinations of the uterus may have better potential for diagnosing focal subendometrial adenomyosis than follicular phase scanning. This is because of the echogenic characteristics of a secretory endometrium relative to the neighbouring inner myometrium. More work is needed to verify these findings and to test our hypothesis.

Paper 21: The Outcome of Arthroscopic Treatment of Lateral Trochanteric Pain Syndrome – A Retrospective Review

An Outcome Study of 30 consecutive patients with Lateral Trochanteric Pain Syndrome who had not responded to 6 months of conservative treatment, and were then treated with Arthroscopic decompression, bursectomy and Radiofrequency microdebridement. Recalcitrant Lateral Trochanteric Pain Syndrome (LTPS), hip pain caused by trochanteric bursitis, gluteus medius and minimus tendinopathy and or tears, is increasingly being treated arthroscopically. We undertook a retrospective review of 30 consecutive patients (31 hips) with a diagnosis of LTPS with or without gluteus medius and minimus tendinopathy or tears. The study period was from 2003 to 2009 and all patients had a minimum follow up of 6 months. Eligible subjects had a history of at least 6 months conservative treatment, and local anaesthetic and steroid injections into their trochanteric bursa leading to a transient improvement of their symptoms. They were subsequently investigated using clinical examination and ultrasound scan (USS) to confirm a pre operative diagnosis of LTPS (with or without trochanteric bursitis and with abductor tendon pathology). No patient had a preoperative Gluteal tendon tear. Surgery was undertaken in the lateral position and an arthroscopic slit of the Iliotibial Band (ITB), trochanteric bursectomy, and radiofrequency microdebridement of the abductor tendons was performed. Post operatively, all subjects were mobilised, full weight bearing, with no restriction in activity. At their latest review, clinical and USS examinations were performed. We report a mean follow up of 15.1 months, (range 6-46 months). The average age at operation was 56 years (range 19 to 80 years), with a mean body mass index of 26.4 (range 18.9-33.3). There were 22 right and 9 left sided procedures. At their last review, 1 patient had a limp and USS demonstrated a Gluteus medius tear and 9 (29%)patients had a positive Trendelenberg sign and USS demonstrated Gluteal tendon tears in 3. 12 (39%) could perform a single leg stance for 30 seconds pain free, and 19 (61%) had no pain with resisted abduction. Analysis of the Outcome Scores demonstrated that the mean Modified Harris Hip Score (MHSS) improved from 63 to 78 points, and the Non Arthritic Hip Score (NAHS) from 60 to 79 points at final review. Follow up USS demonstrated normal tendons in 4 hips (19%), tendonosis/tendinopathy in 11 (52%), partial thickness tears in 4 (19%), and complete tears in 2 (10%). Arthroscopic ITB decompression with trochanteric bursectomy and radiofrequency microdebridement of the hip abductor tendons is safe and effective in the treatment of refractory lateral hip pain. This intervention should be considered in the management of this difficult condition in selected patients with mild to moderate gluteal tendinopathy

Increased prevalence of non-alcoholic fatty liver disease in European women with a history of gestational diabetes

Non-alcoholic fatty liver disease (NAFLD) is common in type 2 diabetes but it is unknown whether NAFLD is prevalent in European women at risk of type 2 diabetes. We studied the prevalence of, and risk factors for, NAFLD in European women with previous gestational diabetes (GDM) at high risk of type 2 diabetes. A total of 110 women with previous GDM and 113 without previous GDM, with non-diabetic glucose tolerance were recruited retrospectively from antenatal databases. Participants underwent liver ultrasound scan examination, anthropometry and blood sampling for liver function tests and to determine levels of fasting lipids, NEFA and insulin and glucose concentrations in order to derive insulin sensitivity and insulin secretion indices (HOMA%S and HOMA%B, respectively). There was no significant difference in BMI in women with previous GDM compared with those without previous GDM (28.9 ± 0.6 vs. 27.9 ± 0.6kg/m(2), respectively; p = 0.12). Women with previous GDM had higher fasting and 2h glucose concentrations following a 75g OGTT ([mean ± SEM] fasting glucose 5.3 ± 0.1 vs. 5.1 ± 0.1mmol/l, p = 0.02; 2h glucose 6.8 ± 0.2 vs. 5.8 ± 0.3mmol/l, p = 0.02), dyslipidaemia (LDL-cholesterol 3.3 ± 0.1 vs. 2.8 ± 0.1mmol/l; HDL-cholesterol [median {interquartile range}] 1.3 [1.2-1.6] vs. 1.8 [1.5-1.9] mmol/l; triacylglycerol 1.3 [0.9-1.6] vs. 1.0 [0.7-1.7] mmol/l, all p ≤ 0.03), higher insulin secretion and lower insulin sensitivity. NAFLD prevalence was greater in women with previous GDM compared with those without previous GDM: 38% (95% CI 28-47%) vs. 17% (95% CI 10-24%), p = 0.001. In multiple logistic regression analysis, lower insulin sensitivity and raised serum alanine transaminase concentrations were associated with NAFLD. NAFLD is prevalent in European women with previous GDM. Impaired insulin sensitivity and increased liver transaminase activity are closely associated with NAFLD in these women.

Total laparoscopic renal artery bypass for restenosis after failed percutaneous transluminal renal stenting

The purpose of this article was to report our experience of the repair of renal artery restenosis after percutaneous transluminal renal angioplasty (PTRA) using a total laparoscopic technique without robotic assistance. Between February 2005 and October 2009, we performed six total laparoscopic aortorenal artery bypasses for restenosis after failed PTRA. All these patients had recurrent hypertension with renal insufficiency. The mean operative time was 246 minutes (range, 200-310 minutes). The mean warm renal ischemic time was 28 minutes (range, 22-35 minutes). All patients received a prosthetic graft interposition. The estimated surgical blood loss was 980 mL (range, 500-1400 mL). No conversion was observed and no in-hospital deaths occurred. There was no severe postoperative morbidity. Postoperative serum creatinine levels raised in all patients but all returned to baseline before discharge. Median length of postoperative hospital stay was 6 days (range, 4-8 days). Median follow-up was 13 months (range, 7-19 months). Color Doppler ultrasound scan examination and computed tomography (CT) with injection of contrast media showed patency of all bypasses. Hypertension was improved in all patients but renal insufficiency remained unchanged. Total laparoscopic renal artery bypass is feasible and safe in patients after failed PTRA. This approach may reduce the morbidity of open repair but is technically demanding and necessitates a large previous experience in total laparoscopic aortic surgery.

Predictors of Non-Diagnostic Ultrasound Scanning in Children with Suspected Appendicitis

To determine predictors of diagnostically inaccurate ultrasound scanning for suspected appendicitis. Prospective emergency department cohort study of 263 previously healthy children 4 to 17 years of age undergoing ultrasound scanning. Ultrasound scanning results were interpreted as positive, negative, or equivocal for appendicitis and classified as diagnostically accurate and inaccurate. The main outcome measure was association between inaccurate ultrasound scanning and age, sex, body mass index percentiles, pain duration, white blood cell count, Faces Pain Score-Revised, clinical probability of appendicitis, and ultrasound scanning operator. Of the 263 patients, 95 ultrasound scanning examinations were read as positive, 76 as negative, and 92 were equivocal. A total of 162 (61.6%) ultrasound scanning examinations were accurate (TP86, TN76), and 101 (38.4%) ultrasound scanning examinations were inaccurate (FP88, FN13). Children with body mass index percentiles ≥ 85 and clinical probability of appendicitis ≤ 50% had 58.1% probability of inaccurate ultrasound scanning examination (odds ratio, 2.48; 95% confidence interval, 1.48-2.78). In lean children, diagnostic accuracy of the screening ultrasound scanning examination with second ultrasound scanning or clinical reassessment was 93% versus 83% in the obese children (95% confidence interval of the difference, 1-19%). Screening ultrasound scanning for pediatric appendicitis has suboptimal accuracy, particularly in obese children with a low likelihood of appendicitis who should not routinely undergo ultrasound scanning. However, when followed by a second ultrasound scanning or a clinical reassessment, it offers high diagnostic accuracy in lean children.

Febrile Urinary Tract Infections in 0- to 3-Month-Old Infants: A Prospective Follow-Up Study

To track the clinical evolution of febrile urinary tract infection (UTI) diagnosed in 0- to 3-month-old infants and characterize uropathogen frequencies, antimicrobial resistance rates, renal abnormalities, and differences in the sexes in this age group. We observed prospectively 46 infants identified in a cohort of 209 children with first UTI diagnosed between July 2006 and July 2008 at the age of 0 to 3 months. Renal ultrasound scanning and voiding cystourethrography examinations were performed in all infants. Infants < 3 months old represented 21% of all children with first UTI. Of these children, 26% were female and 74% were male. Escherichia coli was isolated in 88% of cases and had a high rate of resistance to ampicillin (71%) and to trimethoprim/sulfamethoxazole (47%); 21% of children had vesicoureteral reflux, which was of low-grade in 67% of cases, with spontaneous resolution before 2 years in all cases. In infants with normal ultrasound scanning results, a low-grade vesicoureteral reflux was subsequently found in 10% of cases. Infants aged 0 to 3 months represent 21% of children treated for febrile UTI. Boys represent 74% of these cases. E coli is responsible for 88% of UTIs, with a high rate of resistance to antibiotics. When ultrasound scanning examination results are normal, the risk of missing a significant renal abnormality is expected to be extremely low.

Follow-Up of BI-RADS 3 Breast Mammograms, Results of a West France “Departement” Breast Cancer Screening Programme.

Abstract Background: French breast cancer screening program lies on a decentralized system. Each administrative division of a region (departement) organizes, coordinates and assesses their programme under the aegis of the French National Cancer Institute (INCa).The screening programme includes every two years, for women between 50 and 74 years of age a clinical examination and a breast mammogram. Conclusions are reported using the Breast Imaging and Reporting Data System (BI-RADS) of the American College of Radiology (ACR).French recommendations for low-suspicion lesions of the breast (BI-RADS 3) consist in a new screening 4 or 6 months later, then another one at one year and a third one year later before returning to the breast screening programme.Objectives: To evaluate the medical organisation and patients' observance for the follow-up of low suspicion breast lesions (BI-RADS 3).Material and Methods: Between January 2005 and January 2007 every BI-RADS 3 breast mammogram exams were listed in our departement and each radiologist was asked about their patient's health status.Patients who had not had their control mammogram were contacted.Their general practitioners were asked in case of no response.Results: Between January 2005 and January 2007 126 385 women were invited to take part in the breast cancer screening programme (screening rate 59.55%).2 209 exams were considered BI-RADS 3 (2.90%).383 patients (17.5%) were lost of sight.2111 women underwent an ultrasound scan examination (40.67%).20 women had MRI (0.39%).182 had biopsies (8.23%).BI-RADS 3 predictive value for a breast cancer lesion was 3.35%.Control mammograms were proposed at 4 months for 339 patients (18.7%) and 6 months for 1 125 patients (62.1%).1247 patients had only one control mammogram (60.9%), 388 (18.9%) patients had two and 60 (2.9%) had at least 3 controls.47.2% of BI-RADS 3 was re classified after first control and 60% after second control.Patients' observance was 91.26% for the first control, 62.9% for the second and decreased to 27% at fourth.1226 (55.5%) were re classified BI-RADS 1 or 2.185 (8.4%) were up graded to BI-RADS 4 or 5.154 (7%) are on attempt of re classification, 152 (6.90%) had no definitive conclusion after 24 months and 109 (4.90%) declined the medical follow-up supervision.The median time needed for re classified BI-RADS 3 was 276 days.Discussion: Our BI-RADS 3 rate (2.90%) is similar to those already published (3-7.7%).French recommendations are applied for the first and second control.Our cancer rate for BI-RADS 3 lesions (3.35%) is higher than those published (0.3%-1.7%).Patients' observance decreases rapidly, and patients' loss-of-sight remains high (17.3%).Initial BI-RADS 3 classification must be improved and recommendations for follow-up may be modified into a delayed control at 9 months that could settle for a BI-RADS 2 classification or lead to a histopathological exam.Waiting for new recommendations, we now contact each woman with BI-RADS 3 one month before control and in the absence of control we contact radiologist and general practitioner to improve observance and reduce the number of lost-of-sight patients. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4013.

Clinical characteristics of suspected combined hamartoma of the retina and retinal pigment epithelium

To analyze the clinical presentations, and explore the diagnosis, and differential diagnosis of combined hamartomas of the retina and retinal pigment epithelium (CHRRPE). A retrospective review of five patients with suspected CHRRPE presented to Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, from Nov 2001 to July 2008. The clinical presentations, fundus characteristics, fundus fluorescein angiography (FFA), optic coherence tomography (OCT), as well as B ultrasound scan examinations were analyzed. The five patients were all male, ranging in age from 6 to 18 years (mean 12 years). The lesion was unilateral; there were not any associated diseases. Presenting symptoms included painless decrease in vision, metamorphopsia, and discovery of strabismus. Initial visual acuity ranged from 20/333 to 20/50. Locations of the lesion included on optic disk and adjacent retina, and in the macular area. Clinical characteristics were slight elevation on optic disk or in retina, different degree of hyperpigmentation, retinal vascular tortuosity, as well as epiretinal membrane formation. In arterial phase of FFA, there was hypofluorescence of choroid background, retinal vascular was tortuous and telangiectatic, and there was leakage from vessels within the lesion in venous phase and late phase. OCT showed obscuration of the normal retinal layers, elevated lesion with high reflectivity of the inner retina, and hyporeflective shadowing of the underlying tissue. B ultrasound scan showed slightly elevated solid mass involving the disc or adjacent retina in some patients. CHRRPE may be confused with other masses of the retina and choroid. Diagnosis of CHRRPE mainly depends on fundus manifestations, FFA and OCT. B ultrasound scan is useful for differential diagnosis.

The impact on ovarian reserve after laparoscopic ovarian cystectomy versus three-stage management in patients with endometriomas: a prospective randomized study

To investigate the effect of two different laparoscopic methods on ovarian reserve in patients with ovarian endometriomas. Prospective, randomized clinical trial. Endoscopy unit of a university hospital. Twenty women with endometriomas. Patients were randomly selected to undergo either laparoscopic cystectomy for endometrioma (group 1) or the "three-step procedure" (group 2). Before and 6 months after laparoscopy all patients were evaluated, and 12 months postoperatively they underwent ultrasound scan examination. The primary end point was ovarian reserve damage based on the alterations of anti-Müllerian hormone (AMH). Secondary end points were the changes of antral follicle count and serum concentration of FSH, LH, E(2), and inhibin B. Mean serum AMH was reduced significantly from 3.9-2.9 ng/mL in group 1 compared with the reduction from 4.5-3.99 ng/mL in group 2. Ovarian reserve determined by AMH is less diminished after the three-step procedure compared with cystectomy of endometriomas.

Congenital vascular malformations: A series of five prenatally diagnosed cases

In the literature there are single case reports of mediastinal/chest and limb combined vascular malformations (previously labeled "hemangiolymphangiomas"). A variable outcome in such prenatally diagnosed cases is reported. Presented here is the only series of patients reported with these macrocystic, predominantly lymphatic malformations. Prenatal ultrasound scan and post-mortem examination findings are described. In our experience the outcome has been poor and this highlights the dilemma faced by clinicians and parents when these lesions are diagnosed prenatally. We present a series of five, prenatally diagnosed vascular (combined vascular malformations and simple localized lymphatic malformations) malformations. Three cases had lower leg involvement with extension into the abdomen and two cases had lymphatic malformations of the chest wall with involvement of the upper limb(s). Management of a twin pregnancy, in which one twin was affected, is described. In two cases, termination of pregnancy was undertaken because of the extensive nature of the lesion. One case died in utero and one in the neonatal period. The fifth case is an 11-year-old boy, whose lower limb deformity illustrates the considerable morbidity associated with this condition.

Preterm infants with video-EEG confirmed seizures: Outcome at 30 months of age

Objective Our aim was to identify early predictors of poor neurodevelopmental outcome and of subsequent epilepsy in very early preterm and late preterm newborns with neonatal seizures. Study design: Fifty-one preterm infants with gestational age (GA) ⩽36 weeks were identified among those admitted to the NICU of University Hospital of Parma between January 1999 and December 2003 and prospectively followed-up. They were subdivided in two Groups: early preterm newborns with a GA ⩽29 weeks and those with GA between 30 and 36 weeks. Selection criteria included multiple digital-video-EEG confirmed neonatal seizures and a follow-up of at least 30 months. Independent variables considered for analysis included neonatal risk factors, etiology and type of seizures, EEG activity, and cerebral ultrasound scan examinations. Results: Ten infants had a favorable outcome, 17 died, and 23 had an adverse outcome. One infant was lost on follow-up. Apgar score at 1 min (O.R. = 15.457, 95% CI: 2.236–106.850, p = 0.006) and severely abnormal background EEG activity (O.R. = 8.298, 95% CI: 1.316–52.301, p = 0.024) were independent predictors of abnormal outcome. Nine infants presented post-neonatal epilepsy. Severely abnormal Cerebral Ultrasound scans were predictive of epilepsy (O.R. = 13.72, 95% CI: 1.959–96.149, p = 0.008). Conclusions: Neonatal seizures in preterm infants are associated to a high rate of mortality and severe morbidity in survivors but no definitive differences between the two groups of preterm infants were found. Risk-factors for development of subsequent epilepsy are strongly related to the underlying brain damage.

Stroke Symptoms and the Decision to Call for an Ambulance: Turn on People’s Minds!

To the Editor: We read with great interest the article by Mosley et al1 on factors related to calling an ambulance for stroke patients. The authors reported that “stroke” was referred as the problem (unprompted) by ≈50% of callers, whereas fewer than half of the calls were made within 1 hour from symptom onset. We agree with the authors on the necessity of interventions to more strongly link stroke recognition to immediate action to increase the number of stroke patients …

Circadian Changes in Uterine Artery and Ovarian Stromal Blood Flow After Pituitary Down-regulation

To investigate changes in the uterine artery and ovarian stromal blood flow in relation to the time of the day after pituitary down-regulation during in vitro fertilization treatment. Thirteen women were recruited. The uterine artery blood flow was studied using pulsed color Doppler ultrasonography and the ovarian stromal blood flow was measured using three-dimensional power Doppler ultrasonography. Ultrasound scan examinations and blood pressure measurements were performed in the morning and evening. The diastolic and the mean arterial pressures were significantly higher in the evening. An increase in the uterine artery pulsatility index and resistance index in the evening was observed. The ovarian vascularization index, vascularization flow index, and right ovarian flow index were significantly lower in the evening. Despite the small sample size, we have demonstrated the presence of a diurnal change in uterine artery and ovarian stromal blood flow after pituitary down-regulation. Such changes may be related to the systemic change in the sympathetic system and hence vascular resistance. Future study regarding ovarian stromal blood flow should take into account the effect of the time of the day on the readings in order to avoid misleading interpretation of data.

Comparison Between Duplex Scanning and Angiographic Findings in the Evaluation of Functional Iliac Obstruction in Top Endurance Athletes

Objective Review of a 10 year-experience, to evaluate the efficacy of pre-operative investigations in the detection of external iliac artery (EIA) endofibrosis in top endurance athletes. Design Retrospective study. Materials From September 1995 to March 2004, 13 highly-trained athletes (all men, mean age 32.3 years) underwent surgery for disease involving 14 lower limbs (11 left, one right, one bilateral). Methods We compared ultrasound scan (US) and digital subtraction angiography (DSA) data, at rest and at hip flexion with intra-operative findings for all 14 lower limbs. We analyzed the presence of stenosis in the external and common iliac arteries, the presence of psoas muscle arteries and the presence of excessive EIA length. Results In the affected limbs, before treatment, the mean ankle brachial index (ABI) at rest was 0.98 compared with 0.56 after exercise, p=0.0001. The sensitivities of the US vs DSA examination in the detection of external and common iliac artery stenosis were, respectively, 84.6 and 53.8% vs 53.8 and 12.5%. The muscle psoas artery was detected by DSA with a sensitivity of 57.1 and 100% specificity. For the detection of excessive EIA length, the sensitivity of US was 85.7% with 57.1% specificity. Conclusions A fall of ABI after exercise proves the presence of a significant stenosis in symptomatic athletes. Color coded duplex ultrasonography is recommended for non-invasive imaging of suspected endofibrotic stenosis in young athletes, since it detects reliably both stenosis and elongation of iliacal arteries.

Preoperative sonographic evaluation is a useful method of detecting contralateral patent processus vaginalis in pediatric patients with unilateral inguinal hernia

Background/purpose To analyze the value of ultrasound scan (US) in the preoperative identification of a contralateral patent processus vaginalis (CPPV), the authors investigated the presence of CPPV by US in children with clinically diagnosed unilateral inguinal hernias. Methods Three hundred forty-eight patients (168 boys and 180 girls) with unilateral inguinal hernia underwent US examination using a 7.5-MHz linear transducer. If a CPPV was visible as a hydrocele owing to the inflow of physiologic ascites into a processus vaginalis on straining, then US scanning was performed while the patient was at rest and while inducing straining by standing or crying. A groin with a hydrocele in the inguinal canal on straining was diagnosed as a CPPV and was explored bilaterally through surgery. The US findings were compared with surgical results. Results In 348 patients, 78 cases (22.4%) were diagnosed by US as patients with a CPPV; these patients underwent bilateral surgery. Seventy-four of 78 cases (94.9%) were confirmed surgically as patients with CPPV. Conclusions A CPPV was detected correctly by US in 74 of 348 patients (21.3%) with clinically diagnosed unilateral inguinal hernias. US is a noninvasive and accurate method for evaluating the presence of a CPPV.

A comparison of diagnosis of pregnancy in the goat via transrectal ultrasound scanning, progesterone, and pregnancy-associated glycoprotein assays

Real-time ultrasound scanning (US) via the transrectal route, progesterone (P4) assay, and pregnancy-associated glycoprotein (PAG) detection can be used to diagnose pregnancy at around 3 weeks after breeding. Although several studies have been carried out to evaluate each of these different methods individually, it is difficult to establish adequate comparisons due to differences, such as the breed of goat, age, and farming conditions, among others. The aim of the present paper is to compare the accuracy of diagnosis of pregnancy using transrectal US, P4 assay and PAG detection at the same time and on the same animals. Canary dairy goats ( n=143) were synchronized with an 11-day fluorogestone acetate (FGA) intravaginal sponge followed by PGF 2α and eCG 2 days before the FGA withdrawal. Blood samples were collected on Days 20, 22, 24, and 26 after mating to determine P4 and PAG concentrations. Transrectal US examinations were performed at the same time. There were 79 pregnant goats and another 64 non-pregnant. The US via the transrectal method and the determination of PAG concentrations provide very accurate pregnancy diagnosis at 24–26 days after breeding; on the contrary, P4 assay on plasma samples performed on Day 22 after breeding was accurate, in this case, in detecting pregnant animals but did not always detect the non-pregnant does.

Disease progression in contralateral carotid artery is common after endarterectomy.

Although the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the Asymptomatic Carotid Atherosclerosis Study (ACAS) have helped to define the role of carotid endarterectomy (CEA) for both symptomatic and asymptomatic lesions, the role of surveillance of the contralateral carotid artery remains unclear. The purpose of this study was to determine the progression of contralateral carotid artery disease with serial duplex ultrasound scans after CEA compared with the recurrent stenosis rate for the carotid artery ipsilateral to the CEA. From January 1990 to December 2000, 473 CEA procedures were performed at a Veterans Affairs Medical Center. From this group we identified 279 patients who had undergone first-time CEA, as well as preoperative duplex scanning and postoperative duplex scanning at least once, in the vascular laboratory. At each visit stenosis of the internal carotid artery (ICA) was categorized as none (0%-14%), mild (15%-49%), moderate (50%-79%), severe (80%-99%), or occluded. Analysis of probability of freedom from progression was determined. Progression was defined as an increase in ICA stenosis 50% or greater or increase to a higher category of stenosis if baseline was 50% or greater. The Cox proportional hazards model was used for data analysis. Mean patient age was 65.7 years (range, 33-100 years). The 1024 carotid duplex ultrasound scanning examinations performed (mean, 3.7; range, 2-13) included the last study done before the index CEA and all studies done after the CEA. Mean follow-up was 27 months (range, 1-137 months). Forty-six patients were found to have contralateral carotid occlusion at initial duplex scanning, and were therefore excluded from the contralateral progression analysis. Contralateral progression was more frequent than ipsilateral recurrent stenosis at long-term follow-up (P <.01). Annual rates of "any progression" and "progression to severe stenosis or occlusion" were 8.3% and 4.4%, respectively, for contralateral arteries, and 4.3% and 2.4%, respectively for ipsilateral arteries. As a result of surveillance, 43 contralateral CEAs (19% of initial cohort) were performed. Carotid stenosis regressed in 25 arteries (10.7%). Baseline clinical and demographic factors did not predict disease progression. Baseline contralateral stenosis did not predict time to "any progression," but was a strong predictor of "progression to severe stenosis or occlusion" (P <.001). After CEA, we identified an 8.3% annual rate of progression of contralateral carotid artery stenosis and a 4.4% annual rate of progression to severe stenosis or occlusion. Baseline contralateral stenosis was significantly predictive of progression to severe stenosis or occlusion. Clinical and demographic factors were not helpful in predicting which patients would have disease progression. These data may help in assessing the cost effectiveness of duplex scanning surveillance after CEA.

Effects of carvedilol therapy on restrictive diastolic filling pattern in chronic heart failure

BackgroundCarvedilol therapy during congestive heart failure demonstrated a good efficacy in mortality rate reduction and in improvement of left ventricular (LV) systolic performance. However, currently there is not any finding about the drug's effect on diastolic filling. The aim of this study was to evaluate the effects of β-blocker treatment on LV diastolic function with an eco-pulsed Doppler ultrasound scanning examination at transmitral level in a group of patients who were affected by heart failure with a restrictive filling pattern. MethodsWe studied 27 patients with idiopathic or ischemic dilated cardiomyopathy with LV severe systolic disfunction (ejection fraction <35%). Fourteen patients were randomized to receive carvedilol treatment (carvedilol group), and 13 patients continued to receive standard therapy with angiotensin-converting enzyme inhibitors, diuretics, and vasodilators (placebo group). All patients underwent an echo-Doppler ultrasound scanning examination at the beginning of the study and after 4 and 12 months of treatment. ResultsIn the carvedilol group, we found a progressive improvement of Doppler ultrasound scanning parameters after 4 months, with a significant increase of A wave (P <.005), deceleration time (DT; P <.02) and isovolumetric relaxation time (IVRT; P <.02). These improvements were confirmed after 1 year of follow-up, whereas patients in the placebo group did not shown any significant modifications. After 1 year, the differences in these groups were more significant for A wave (39 ± 4 cm/sec carvedilol group vs 30 ± 4 cm/sec placebo group; P <.0001), for E/A ratio (1.8 ± 0.2 carvedilol group vs 2.6 ± 0.5 placebo group; P <.0002), for DT 1(40 ± 16 msec carvedilol group vs 112 ± 13 msec placebo group; P <.001), and for IVRT (74 ± 8 msec carvedilol group vs 57 ± 7 mesc placebo group; P <.0002). These changes seem to happen before systolic and morphological modifications. ConclusionOur results show that carvedilol therapy is a means of modifying parameters of diastolic filling favorably in patients with heart failure. These effects seem to be independent of those of systolic function. The improvement of systolic performance occurs after 1 year of treatment. The restrictive filling pattern, related to an unfavorable prognosis, changes toward pseudonormal or altered relaxation pattern during carvedilol therapy. Further investigations with a greater sample size will be necessary to confirm our findings.

Radiological outcome of innocent infant hip clicks.

Radiographic follow-up is questioned for infants with hip clicks who have normal results from ultrasound scan examination of the hips. Infants whose sole risk factor for developmental dysplasia of the hip was a soft tissue hip click who had a normal ultrasound scan on initial assessment were identified. A follow-up 6-month pelvis radiograph was assessed. The acetabular index, position of femoral ossific nucleus and Shenton's line were measured. Rotated radiographs were excluded. One hundred and seventy-one infants (193 clicking hips) met the criteria for inclusion. All parameters measured were within normal ranges. In this study infants with hip clicks and a normal hip ultrasound scan on initial assessment had a normal radiograph at 6 months.

Rapid recurrence of endometrioma after transvaginal ultrasound-guided aspiration

Objective: Ultrasound-guided aspiration is a less invasive management option for recurrent endometrioma. We postulated that the endometriotic tissue in the epithelial lining of endometrioma had undergone pressure atrophy after a period of observation, and resolution of the endometrioma can be achieved by aspiration of its content. Study design: A prospective study was carried out in which patients with recurrent endometrioma that remain stationary in size for a period of at least 6 months were included. Ultrasound-guided aspiration of endometrioma was performed transvaginally under conscious sedation. Ultrasound scan examination was performed at 1, 3, 6, and 12 months after aspiration to detect recurrence. Results: Eight endometriomas were aspirated in six patients. The mean diameter and volume of endometrioma at aspiration were 31.0 mm (range, 18.0–46.3 mm) and 21.9 ml (range, 3.16–52.0 ml), respectively. There were no major complications. Cytological examination revealed hemosiderin-laden macrophages; neither malignant cells nor endometrial cells were detected in all cases. Six ovarian cysts recurred in five women (83.3%), all recurrence were detected within 3 months after aspiration. Conclusion: We concluded that although transvaginal ultrasound-guided aspiration is a safe procedure, but the recurrence rate after aspiration is unacceptably high, and hence cannot be recommended as a treatment option for recurrent endometrioma.