Causes of increased renal medullary echogenicity in Turkish children

The primary disorders of 50 children with increased renal medullary echogenicity on renal ultrasound were studied; 28 girls and 22 boys aged from 1 month to 16 years were classified into four groups based on underlying disease and ultrasound findings. Group 1 was composed of 17 patients with distal renal tubular acidosis (34%); intense echoes throughout the pyramid were predominant. Group 2 consisted of 14 patients with vitamin D toxicity (28%) and an intense echogenic rim around the pyramids. Group 3 included 10 patients with different types of tubulopathies. A slight hyperechogenic rim around the sides and tip of the medullary pyramids was detected. Group 4 was made up of 9 patients with rare underlying conditions. Abdominal X-rays detected medullary calcinosis in only 12 (24%) of the total 50 patients. Ultrasonography appears to be an important tool in the early diagnosis of increased renal medullary echogenicity and medullary nephrocalcinosis.     

肌肉超声回声联合血浆炎性因子对ICUAW诊断及预后评估的价值研究

目的 探讨重症监护病房（intensive care unit,ICU）获得性肌无力（ICU acquired weakness,ICUAW）患者肌肉超声回声与血浆炎性因子的相关性,以及其对ICUAW的诊断价值和预后的预测价值。方法 选择重庆市急救医疗中心ICU住院患者,分别在第1、3、7天使用床旁超声检测患者肌肉回声,获得的总体肌肉回声评分（global muscle echogenicity score,GEM）,测定血清白细胞介素-6（interleukin-6,IL-6）和降钙素原（procalcitonin,PCT）浓度,采用医学研究理事会肌力评分法（medical research council scales,MRC-ss）评估肌肉力量。根据患者入ICU第7天MRC-ss评分将患者分为ICUAW组和非ICUAW组,分析比较2组患者GEM、IL-6、PCT的差异及各指标的相关性。利用受试者工作特征（receiver operator characteristic,ROC）曲线分析以上参数对ICUAW诊断效能,分析GEM、IL-6、PCT对ICUAW患者的预测预后价值。结果 ICUAW组第3天GEM、第7天IL-6浓度、GEM高于非ICUAW组（P<0.05）。GEM与第7天IL-6水平呈正相关（r=0.221）,第7天GEM与MRC-ss评分呈负相关（r=-0.581）。ROC曲线分析显示,第7天GEM对ICUAW有诊断预测价值,ROC曲线下面积（area under the curve,AUC）为0.838,使用GEM、IL-6、PCT联合诊断,AUC=0.885（P<0.05）。ICUAW组Barthel指数评分（Barthel index,BI）低于非ICUAW组,ICUAW组中总体肌肉超声回声评分（global muscle echogenicity score,GEM）高的患者BI低于GEM低的患者（P<0.05）。结论 ICU住院患者GEM与IL-6、PCT浓度相关,其对ICUAW具有一定的诊断价值,并能够预测ICUAW患者的预后。     

Comparative Echogenicity of an Epidural Catheter and 2 New Catheters Designed for Ultrasound‐Guided Continuous Peripheral Nerve Blocks

Visualization of the catheter during ultrasound‐guided continuous nerve block performance may be difficult but is an essential skill for regional anesthesiologists. The objective of this in vitro study was to evaluate 2 newer catheters designed for enhanced echogenicity and compare them to a widely used catheter not purposely designed for ultrasound guidance. Outcomes were the numbers of first‐place rankings among all 3 catheters and scores on individual echogenicity criteria as assessed by 2 blinded reviewers. Catheters designed for echogenicity are not superior to an older regional anesthesia catheter, and results suggest that catheter preference for ultrasound‐guided placement may be subjective.     

Echogenic endometrial fluid collection in postmenopausal women is a significant risk factor for disease.

OBJECTIVE: The purpose of this study was to assess postmenopausal women with endometrial fluid collection and the risk of significant endometrial or cervical disease. METHODS: A retrospective chart review was conducted of 343 postmenopausal women with endometrial fluid collection on pelvic sonography. Medical records were reviewed to identify women who underwent an evaluation of the endometrium with endometrial biopsy, hysteroscopy, or hysterectomy after the sonographic examination. Clinical and sonographic characteristics were compared between women with diagnoses of cervical or endometrial cancer or hyperplasia (nonbenign group) and women with benign conditions (benign group). RESULTS: The endometrium was significantly thicker in the nonbenign group compared with the benign group (mean +/- SD, 9.9 +/- 7.4 versus 5.9 +/- 4.1 mm; P = .016). None of the patients with adenocarcinoma of the endometrium had endometrial thickness of 3 mm or less, but 2 with endocervical cancer did. Echogenic fluid in the endometrial cavity was significantly more likely to be found in the nonbenign group compared with the benign group (45.8% versus 4.8%; P < .01). Multivariate logistic regression analysis revealed that echogenic fluid in the endometrial cavity was the only significant risk factor for nonbenign conditions (odds ratio, 10.94; 95% confidence interval, 2.67-44.84; P < .01). CONCLUSIONS: Postmenopausal women with endometrial fluid collection on sonography should undergo endometrial sampling if the endometrial lining is thicker than 3 mm or the endometrial fluid is echogenic. If the lining is 3 mm or less and the endometrial fluid is clear, endometrial sampling is not necessary, but we recommend endocervical sampling to rule out endocervical cancer.