The sonographic appearance of acute focal pyelonephritis 8 years experience

AIM: Acute focal pyelonephritis (AFP) is a variant of pyelonephritis in which single or multiple discrete areas show changes of inflammation. The reported sonographic appearances of AFP are varied but are typically described as being echopoor. The purpose of this study was to review the sonographic appearances of AFP and attempt to explain the range of findings by correlation with clinical details. MATERIALS AND METHODS: We reviewed retrospectively the sonographic findings and medical records of 17 cases of AFP. The study group consisted of 13 women and four men (mean age 20 years). Lesions were designated as echogenic, echopoor or of mixed echogenicity as compared to the adjacent renal cortex, and to the liver or spleen. RESULTS: The abnormal areas were echogenic in 12 patients, echopoor in three and of mixed echogenicity in two. An attempt was made to explain the variation in appearances by correlation with clinical details including the patient's age, the duration of symptoms, the length of antibiotic treatment and the presence of haematuria. CONCLUSION: Areas of acute focal pyelonephritis may be echogenic, echopoor or of mixed echogenicity. Our data would suggest that areas of increased echogenicity are more common. There is no discernible correlation with clinical findings.     

The ‘Sandwich Sign’ of Mesenteric Lymphoma

A proteomic approach was applied to study the protein expression profile of peripheral T‐cells derived from patients at the onset of different B‐lymphoproliferative diseases, because a rising interest in specific actions played by T‐cells in such pathologies has emerged. Decreased levels of profilin‐1 and cofilin‐1 and increased levels of coronin1A and prohibitin were found in patients, compared with healthy controls. The protein‐protein interaction network of these proteins was studied using a web‐based bioinformatics tool, highlighting the actin cytoskeleton regulation as the main biological process involved in peripheral T‐cells of such patients. Unsupervised cluster analysis of protein expression data shows that the recorded alteration of T‐cell proteome was specifically induced by B‐cell pathologies.     

The varied sonographic appearances of focal fatty liver disease: review and diagnostic algorithm

Focal fat infiltration and focal fat sparing of the liver are less common than diffuse fat infiltration but present a greater diagnostic conundrum. Although typical features of these conditions are well described, there is a wide variety of different appearances. These atypical patterns present significant difficulty in differentiation from other pathological processes and often require additional investigation. We present an innovative diagnostic algorithm and illustrate its effectiveness in diagnosing focal fatty liver disease with typical and atypical examples.     

The Kimray-Greenfield filter: evaluation by duplex real-time/pulsed Doppler ultrasound

The Kimray-Greenfield filter is a wire cage which is inserted into the inferior vena cava (IVC) to prevent thrombi originating in pelvic and leg veins from embolizing to the lungs. Duplex real-time/pulsed Doppler ultrasound was used to evaluate placement and function in 38 patients (46 examinations). Real-time examination successfully identified the IVC and filter in 89% of cases. Pulsed Doppler studies demonstrated flow above and below the filter in 76%, accurately predicting normal flow in most cases. In 4 patients, Doppler scans revealed little or no flow distal to the filter; contrast cavograms confirmed obstruction secondary to thrombosis. This appears to be an accurate, noninvasive method of assessing postoperative reliability of the Kimray-Greenfield filter.     

Visceral slide for intraperitoneal adhesions? A prospective study in 48 patients with surgical correlation

Bowel perforation in patients undergoing laparoscopic surgery is an uncommon but serious complication. Bowel adherent to the anterior abdominal wall due to adhesions is considered a particular risk. It has been suggested that transabdominal ultrasound can reliably predict the presence of intraperitoneal adhesions. Normal bowel excursions (visceral slide) in 15 volunteers with no history of surgery or peritonitis and in 48 patients undergoing abdominal surgery were evaluated. Visceral slide during spontaneous respiration (SRSL) with manual compression (MCSL) and exaggerated respiration (ESL) was assessed in all 4 quadrants. Adhesions were found in 43 quadrants (12 in the RUQ, 6 in the LUQ, 14 in the RIF, and 11 in the LIF) in 21 patients at surgery. Reduced SRSL detected fibrous adhesions in 6 of 15 quadrants, but only 3 of 28 fibrinous adhesions, with an overall sensitivity of 21%, specificity of 94%, and accuracy of 76%. MCSL detected 9 of 15 fibrous and 9 of 28 fibrinous adhesions, with an overall sensitivity of 42%, specificity of 73.5%, and accuracy of 62%. ESL detected 6 of 15 fibrous and 3 of 28 fibrinous adhesions, with an overall sensitivity of 20%, specificity of 76%, and accuracy of 63%. Preliminary results suggest that ultrasound can detect adhesions preoperatively, but the overall sensitivity is poor and the number of false-positives and false-negatives make it unreliable for routine use. © 1995 John Wiley & Sons, Inc.