Current relevance of cervical ultrasonography in staging cancer of the esophagus and gastroesophageal junction

PURPOSE: To evaluate the value of external ultrasonography (US) of the neck in current dedicated preoperative staging of patients with cancer of the esophagus and gastroesophageal junction (GEJ). MATERIALS AND METHODS: We analyzed 180 consecutive patients (154 men, 26 women, and mean age 63 (38-84) years) without palpable cervical lymphadenopathy, treated between January 2001 and March 2006. Suspicious lesions were confirmed by cytological examination. All first 125 consecutive patients (group A) were staged by standard endoscopic ultrasonography (EUS), multidetector computed tomography (md-CT), positron emission tomography with (18)F-fluorodeoxyglucose (FDG-PET) and external US. The other 55 patients (group B) were prospectively staged according to a revised protocol consisting of routine EUS and md-CT, while PET was only performed in subjects with T3-T4 and/or N1 disease and external US solely on indication. RESULTS: Cervical metastases were found in seven patients from group A (6%) and in five from group B (9%). Twenty percent (4/20) of the tumors above the carina and 5% (8/160) of the distal tumors presented with cervical metastases. All were diagnosed as T3 and T4 tumors on EUS. Eleven of these metastases were detected by external US and nine on md-CT. All nodal metastases were detected by the combination of PET and md-CT. No cervical metastases were missed by the diagnostic algorithm in group B. CONCLUSION: In present staging procedures for esophageal cancer, routine external US seems to have no additional value in detecting cervical metastases. It is still indicated to obtain cytological proof of suspected cervical lesions.     

Computer-aided differentiation of malignant from benign solitary pulmonary nodules imaged by high-resolution CT

We investigated the possibility of using computer analysis of high-resolution CT images to radiologically classify the shape of pulmonary nodules. From a total of 107 HRCT images of solid, solitary pulmonary nodules with prior differentiation as benign (n=55) or malignant (n=52), we extracted the desired pulmonary nodules and calculated two quantitative parameters for characterizing nodules: circularity and second central moment. Using discriminant analysis for two thresholds in differentiating malignant from benign states resulted in a sensitivity of 76.9%, a specificity of 80%, a positive predictive value of 78.4%, and a negative predictive value of 78.6%.     

混合模式成像在胆囊疾病的应用价值

目的:探讨三维超声的混合模式成像在胆囊疾病中的应用价值。方法:对78例患者的胆囊行二维及三维超声检查,以混合模式进行三维超声重建,评价三维超声是否能够优于二维,获得更多的诊断信息。结果:重建的三维图像清晰、直观、具有较强的立体感。①三维超声可以显示结石的数目、光滑的表面;②可以显示息肉的部位、表面乳头状或桑葚状的特征、与胆囊壁的关系、基底部、蒂的长短;③可以清晰显示腺肌症增厚的胆囊壁及特征性的罗阿氏窦;④可以显示胆囊癌病灶基底部对胆囊壁及周围组织的浸润程度。结论:三维超声混合模式重建图像可以直观地显示胆囊疾病的形态特点及与周围组织的结构关系,与二维超声联合应用,有利于胆囊疾病的诊断。     

Value of comprehensive renal ultrasound in children with acute urinary tract infection for assessment of renal involvement: comparison with DMSA scintigraphy and final diagnosis

The aim of this study was to evaluate the value of comprehensive renal ultrasound (US), i.e., combining greyscale US and amplitude-coded color Doppler sonography (aCDS), for assessment of urinary tract infection (UTI) in infants and children, compared to (1) ^99mTc DMSA scintigraphy and (2) final diagnosis. Two hundred eighty-seven children with UTI underwent renal comprehensive US and DMSA scintigraphy. The results were compared with regard to their reliability to diagnose renal involvement, using (1) DMSA scintigraphy and (2) final diagnosis as the gold standard. Sixty-seven children clinically had renal involvement. Sensitivity increased from 84.1% using only aCDS to 92.1% for the combined US approach, using DMSA scintigraphy as the reference standard. When correlated with the final diagnosis, sensitivity for DMSA scintigraphy was 92.5%; sensitivity for comprehensive US was 94.0%. Our data demonstrate an increasing sensitivity using the combination of renal greyscale US supplemented by aCDS for differentiation of upper from lower UTI. Sensitivity for DMSA and comprehensive US was similar for both methods compared to the final diagnosis. Comprehensive US should gain a more important role in the imaging algorithm of children with acute UTI, thereby reducing the radiation burden.     

种植性兔VX2肝肿瘤血供的研究

目的探讨种植性兔VX2肝肿瘤生长的自然血供特点。方法VX2瘤株接种于新西兰兔肝左叶,制成模型瘤兔15只,将其按瘤体直径分为3组:A组直径<2.0cm、B组直径2.0～3.0cm、C组直径>3.0cm,分别应用彩色多普勒超声仪检测各组VX2瘤兔的门静脉和肝动脉的血流动力学指标,以及肝动脉血管造影显示瘤体供血情况,分析不同直径大小的瘤体血流分布及构成。结果A组的VX2兔肝肿瘤供血不丰富,肝动脉部分参与供血;B组的VX2兔肝肿瘤瘤内血流丰富,供血以肝动脉为主;C组的VX2兔肝肿瘤中心部出现坏死,瘤周血流丰富,供血以肝动脉为主。C组的VX2兔肿瘤肝动脉最大血流速度(Vmax)(60.3±10.9cm/s)与A组(50.4±12.2cm/s)相比有差异(P<0.01),阻力指数(RI)(0.9±0.12)与A组(0.5±0.02)相比有差异(P<0.01);门静脉平均血流速度(V)及门静脉内径(D)各组差异不大(P>0.05)。结论种植性VX2肝肿瘤主要供血血管为肝动脉,肝动脉最大血流速度和阻力指数随肿块增大明显增加,多普勒流速曲线呈高速高阻型;门静脉平均血流速度及门静脉内径随肿块增大变化不明显。     

Ultrasonography of symptomatic rotator cuff tears compared with MR imaging and surgery

Purpose

To compare the accuracy of ultrasonography and magnetic resonance imaging in the detection of rotator cuff tears.

Materials and methods

Ninety-six patients with clinically suspected rotator cuff pathology underwent ultrasonography and magnetic resonance imaging of the shoulder. The findings in 88 patients were compared with arthroscopy or open surgery.

Results

Full-thickness tear was confirmed in 57 cases, partial-thickness tear in 30 cases and degenerative changes without tear in 1. In all 57 cases of full-thickness tear and in 28 out of 30 cases of partial-thickness tear the supraspinatus tendon was involved. The accuracy in the detection of full-thickness tears was 98 and 100% for ultrasonography and magnetic resonance imaging, respectively. The accuracy in the detection of bursal or articular partial-thickness tears was 87 and 90% for ultrasonography and magnetic resonance imaging, respectively.

Conclusions

In experienced hands ultrasonography should be considered as an accurate modality for the initial investigation of rotator cuff, especially supraspinatus, tears.     

Adopt a wait-and-see attitude for patent processus vaginalis in neonates

Purpose: The purpose of this paper is to describe the ultrasonographic findings of the patent processus vaginalis (PPV) in neonates.Methods: The patency of the processus vaginalis was examined by ultrasonography in 117 neonates. The ultrasonographic findings, with increment and decrement of the intraabdominal pressure, were categorized into 6 types as follows: type I, the intraabdominal organ is observed; type II, cystic PPV; type III, the PPV is widened with abdominal pressure increment, the length is ≥20 mm; type IV, the PPV contains moving fluid without PPV widening; type V, the PPV is widened with abdominal pressure increment, the length is less than 20 mm; type VI, others. The authors we regarded types I to IV as PPV with inguinal hernia.Results: Twenty-two of 40 neonates with a birth weight under 2,500 g had PPV, including 8 with type I. Twenty of 37 premature neonates 22 to 37 gestational weeks had PPV, including 8 with type I. Eighty-one percent (13 of 16) of PPV in low-birth-weight neonates and 91% (10 of 11) in premature neonates closed spontaneously. The median ages at the time of spontaneous regression of PPV were 242 days in low birth weight neonates and 262 days in premature neonates.Conclusions: Most premature or low-birth-weight neonates with PPV regress spontaneously. The inguinal hernia in neonates (especially in premature or low-birth-weight neonates) should be observed until at least 9 months of age without attempting hernia repair.     

Evaluation of penile hemodynamic status and adjustment of treatment alternatives in Peyronie's disease

Aim: Erectile dysfunction may be observed in up to 80% of patients with Peyronie's disease. An objective evaluation of the erectile function is attempted to work out in patients with Peyronie's disease. Methods: Penile deformity, sexual function and penile vascular status were analyzed in 123 patients with Peyronie's disease, who had not received any pertinent treatment. Results: Penile deformity, palpable plaque and pain on erection were seen in 112 (91%), 97(78.8%) and 27 (21.9%) of the 123 patients, respectively. Of the 76 patients evaluated by color Doppler ultrasounography, veno-occlusive dysfunction as the vascular component for erectile dysfunction was found in 17 (22.3%), arterial insufficiency in 10(13.1%) and a mixed picture in 23 (30.2%). Conclusion: The documentation of penile erectile function and the determination of the vascular status using color Doppler ultrasonography can guide the appropriate therapeutic choice.     

Retrocaval ureter with vesicoureteric reflux,a very rare entity

Introduction

A circumcaval ureter is a rare congenital anomaly in which the ureter passes behind inferior vena cava. VUR is rarely found in association with retrocaval ureter. Diagnosis and management are difficult. To our knowledge, we report a second case of retrocaval ureter with ipsilateral VUR.

A comparison of gastric emptying of soluble solid meals and clear fluids matched for volume and energy content: a pilot crossover study

We previously demonstrated that the gastric emptying time of different liquids with the same volume mainly depended on their energy content, regardless of differences in composition. In this crossover study, we investigated whether the same applies when soluble solid foods are ingested with water. Ten healthy volunteers ingested one of five test diets consisting of two test meals (Calorie Mate^® 100 and 200 kcal) and three test solutions (water and glucose solutions of 100 and 200 kcal), each given in a volume of 400 ml, and then underwent ultrasonography to measure the gastric antral cross‐sectional area every 10 min for 120 min. The gastric emptying time was defined as the time for the antral cross‐sectional area to revert to its initial value. When test diets with the same energy content were ingested, the gastric emptying curves were nearly identical, regardless of whether the original form was solid or liquid. The median (IQR[range]) gastric emptying times of Calorie Mate^® of 100 kcal with water vs. isocaloric glucose solution were 65 (60–78 [50–80]) vs. 65 (60–70 [50–80]) min (p = 0.58), and for Calorie Mate^® of 200 kcal with water vs. isocaloric glucose solution they were 100 (93–108 [90–120]) vs. 105 (90–110 [90–120]) min (p = 0.54). The median (IQR [range]) for water was 40 (30–40 [30–50]) min. Energy content may be a critical determinant of the gastric emptying time when ingesting soluble solid diets with water.