Soft laser therapy in combination with tebonin i.v. in tinnitus

Lymph node tuberculosis is the most frequent tuberculous manifestation in the otorhinolaryngological area. In 13 patients with histologically verified tuberculous lymphadenitis cervical sonographic examinations revealed characteristic findings. The sonographic features typical for this disease were multiple, enlarged, conglomerating roundish and oval lymph nodes. These lymph nodes were hypoechoic, exhibited dorsal sound amplification and had sharp margins. With caseation, however, there were blurred borders. In cold abscesses an inhomogeneous texture with inhomogeneous shadows was found. Differential diagnosis included non-specific abscess-forming lymphadenitis, lymph node metastases and malignant lymphoma. A tentative diagnosis of cervical lymph node tuberculosis may be made due to the polymorphous sonographic pattern if history and clinical findings are taken into account. A proper histological and microbiological work-up is still essential for confirmation of the sonographic diagnosis.     

Adhesive capsulitis of the shoulder joint: usefulness of dynamic sonography

We studied the value of dynamic sonography in adhesive capsulitis of the shoulder joint in patients with clinically suspected frozen shoulder. The sonographic criterion of adhesive capsulitis was continuous limitation of the sliding movement of the supraspinatus tendon against the acromion of the scapula. Arthrography was regarded as a gold standard in the diagnosis of adhesive capsulitis against which the sonographic results were compared. Among 23 patients with arthrographically documented adhesive capsulitis, sonographic examination showed limitation of movement of the supraspinatus tendon in 21. This sonographic sign therefore has a sensitivity of 91%, a specificity of 100%, and an accuracy of 92% for detecting adhesive capsulitis, making dynamic sonography a reliable technique for the diagnosis of this condition.     

Chorionicity inaccurately predicted by early ultrasound: a case report

Ultrasound has been found to be extremely accurate in diagnosing the chorionicity of multiple gestations. Prenatal counselling and/or planning for selective termination is most often based on the sonographic prediction of chorionicity. We present a case of triplet pregnancy in which early sonographic prediction of chorionicity did not match the pathological diagnosis at delivery.     

A case of primary malignant lymphoma of the bladder

There are few reports of the sonographic appearance of Meckel's diverticulum. We present a case of torsion of a Meckel's diverticulum that was suggested by sonography and confirmed pathologically. We discuss the sonographic differential diagnosis, which includes acute appendicitis, enteric duplication cyst and intestinal volvulus.     

The contribution of ultrasound in urologic diagnosis

Urological diagnosis is considerably improved by the application of sonography. The best results are undoubtedly obtained if the investigations are carried out by an appropriately trained urologist familiar with clinical differential diagnosis. Various sonographic techniques which have proved helpful in this field are discussed, and a novel method for assessing the residual urinary volume is described.     

Echocardiographic assessment of alcohol consumers in different clinical stages

In relation to the importance of cardiac damage in alcohol drinkers this study aims to check the modifications of some cardiac sonographic parameters in drinkers examined at different stages of alcohol intoxication. Seventy-seven male subjects (43 +/- 9 years old) were divided into 3 groups in relation to the biohumoral alterations used for the diagnosis of chronic alcoholism (increase of GGT and MGV). EF, interventricular septum hypertrophy, LVEdD and the presence of left ventricular diastolic failure were considered. All these cardiac sonographic parameters "in toto" were first compared with the same parameters of a group of normal subjects and then the differences of these sonographic parameters between the 3 groups of drinkers were evaluated. These data confirm the early onset of cardiac damage and also that the cardiac alterations may occur before the modifications of the biohumoral parameters considered too. The alterations of the cardiac sonographic parameters considered in this study seem to be a good marker for the identification, quantification and staging of cardiac damage. Interventricular septum hypertrophy, EF and EDV (in this sequence) are to be considered usefull for the diagnosis of cardiac damage in alcohol drinkers. However also LVEdD and the presence of left ventricular diastolic failure are to be evaluated before any therapy.     

Fetal inguinoscrotal hernia: sonographic diagnosis and obstetric management

Fetal inguinal hernia is a rare antenatal diagnosis. We present the sonographic features and outcome of a fetus diagnosed at 36 weeks' gestation as having an (indirect) inguinoscrotal hernia. Sonographic criteria for antenatal diagnosis are discussed within the context of differential diagnoses raised by the presence of a perineal mass. Guidelines for obstetric management and counselling are suggested.     

Powered wheelchairs: are we enabling or disabling?

The sonographic diagnosis of malignant lymphoma in childhood is described. Malignant lymphomas are sonographically relatively uniform: initial enlargement of the lymph nodes and organs involved and disturbance of normal echo texture by mainly hypoechoic lesions can be found. Generally, four sonographic patterns of infiltration are described: diffuse, small nodular, large nodular and bulky type. Secondary, tumor-related or inflammatory complications (e.g. dislocation or compression of vessels, thoracic inlet syndrome, venous thrombosis, ileus, urinary retention, abscess and effusion) can be sonographically evaluated. Response to therapy correlates with normalization of size and echo texture and recovery from tumor-related complications. Differential diagnosis with ultrasound is based on the topographic distribution and echo pattern of infiltration and, with certain restrictions, on the echogenicity of lesions and perfusion feasible with Doppler sonography. The primary diagnosis has to be established histologically.     

Use of ultrasonography methods in the diagnosis of neurogenic paraosteoarthropathy in spinal cord injury

To assess the role of the ultrasonic imaging evaluation of articular lesions suspected to be the initial presentation of heterotopic ossifications (HO), 59 consecutive injured patients were studied. 32 out of 59 patients showed clinical signs of local inflammation in one of the articular sites of the upper or lower limbs, sonographic scans proved to be diagnostic of HO in 7 out of those 32 patients before their radiographic findings. Serial sonographic examinations were performed utilizing a 7.5 MegaHertz transducer probe for 2 months. The imaging abnormalities were correlated with biochemical levels of serum alkaline phosphatase, modifications of radiographic features and bone 99nTC scintigraphy. Scintigraphy revealed to have a high sensitivity but a low specificity for the diagnosis of HO. Also the serum levels of alkaline phosphatase were not a sensitive indicator of early HO in our group of patients. Moreover serial sonographic scans confidently excluded the HO in the 25 patients with no initial signs of the disease without any false negative results. Thus, early sonographic assessment of patients, with spinal cord injury in which local signs of inflammation suggest initial HO formation, revealed to be superior to the other utilized technique for the diagnosis of HO and may be considered a valuable alternative in particular to evaluate the evolutive pattern of this disease.     

Texture analysis of sonographic features of the parotid gland in Sj?gren's syndrome

OBJECTIVE: The purpose of this study was to develop a method for quantitative analysis of the sonographic features of parotid glands as a noninvasive tool for the diagnosis of Sj?gren's syndrome. SUBJECTS AND METHODS: Sonographic texture analyses were performed on the parotid glands of 44 patients with Sj?gren's syndrome, 83 healthy volunteers, and 17 patients with chronic parotitis, using a fast Fourier transform program. RESULTS: Texture analysis of sonographic studies of the parotid gland using a Fourier transform showed that the sum of the normalized radial power spectrum in the low-spatial-frequency region (S value) of the parotid gland was significantly higher (p < .0001) in the patients with definite Sj?gren's syndrome [6.70 +/- 2.13 (x10(5))] than in the 72 age-matched normal volunteers [3.25 +/- 1.08 (x10(5))]. However, patients with probable Sj?gren's syndrome showed S values [3.92 +/- 1.88 (x10(5))] similar to those of the controls. On the other hand, SDs of the echo levels in the parotid gland showed significantly greater (p < .0001) values in patients with definite (4.63 1.07) and probable (4.53 1.47) Sj?gren's syndrome than in the normal controls (3.30 0.76). Discriminant analysis showed that a combination of these two distinctive values increased diagnostic accuracy to 96.9%. Furthermore, S values and SDs correlated well with the qualitative grading of sonographic features and with the gradings of sialography. CONCLUSION: The system we describe for texture analysis of sonographic images is useful in the diagnosis of Sj?gren's syndrome.     

Autocatalytic processing of pro-papaya proteinase IV is prevented by crowding of the active-site cleft

BACKGROUND: To establish the value of saline-filled appendiceal ultrasonography in the the diagnosis of clinically equivocal acute appendicitis. METHODS: Saline-filled ultrasonography was performed in 43 patients with an equivocal clinical diagnosis of acute appendicitis. RESULTS: Sonography diagnosed 31 of 32 patients without acute appendicitis (97%). A normal appendix was visualized in 15 patients (47%), and we identified a normal appendix in 15 of 22 patients (68%) in whom the colon was cleansed with Golytely(R). Sonography diagnosed 10 of 11 patients with acute appendicitis (91%). In three of 10 patients, the findings corresponded to sonographic pitfalls. CONCLUSION: Saline-filled appendiceal ultrasonography enables the detection of a normal appendix and may overcome sonographic pitfalls in acute appendicitis.     

Impact of sonography on the diagnosis and treatment of acute lower abdominal pain in children and young adults

OBJECTIVE: Our purpose was to evaluate the impact of sonographic data on clinical physicians' diagnostic confidence and their treatment of children and young adults with acute lower abdominal pain. SUBJECTS AND METHODS: Senior surgical and emergency department staff completed questionnaires before and after abdominal sonography was performed on 94 of 101 consecutive children and young adults with acute lower abdominal pain, pelvic pain, or both. Physicians who were unaware of sonographic data stated the most likely diagnosis and their level of confidence in their diagnosis and then formulated clinical plans. After they were given sonographic data, physicians again stated the most likely diagnosis, estimated their level of confidence, and formulated revised treatment plans. RESULTS: Sonographic data resulted in revised clinical diagnoses in 52% of the patients. Overall, the gain in diagnostic confidence for the entire study population was 33% (95% confidence interval [CI], 27-38%; p < .0001). The impact on the physicians' confidence was greater in those children and young adults whose diagnoses changed after sonography (mean increase in physicians' confidence, 48.3%; 95% CI, 47-75%). In patients whose diagnoses were not changed after sonography, the mean increase in physicians' confidence was 17.6% (95% CI, 11-24%; p < .0001 [analysis of variance]). Physicians used sonographic data to change initial treatment plans in 43 patients (46%). Of these 43 patients, a lower intensity of care was given to 30 patients (70%) and a higher intensity to 13 patients (30%). CONCLUSION: Sonographic data frequently changed initial clinical diagnoses, thus increasing diagnostic confidence and changing clinical treatment decisions in the setting of acute lower abdominal pain in children and young adults.     

Sonographic features of colon carcinoma seen with high-frequency transabdominal ultrasound

To assess the value of high-frequency ultrasonography as a diagnostic imaging procedure in patients with colon carcinoma, we first evaluated the sonograms of 37 patients who had been already diagnosed with contrast enema and/or colonoscopy as having colon carcinoma. As a result, the sonographic criteria for diagnosis of a possible colon carcinoma were (1) a localized and irregular thickening of the colonic wall with heterogenous low echogenicity, (2) an irregular contour, (3) a lack of demonstrable movement or change of configuration of the bowel on real-time scanning, and (4) absence of wall stratification. During the last 4 years, 41 consecutive patients had findings meeting our sonographic criteria. In 37 patients (90%), the presence of colon carcinoma was confirmed by contrast enema and/or colonoscopy. Our study suggests that high-frequency real-time ultrasonography may be a useful imaging technique in diagnosis of colon carcinoma.     

Prune-belly syndrome in a female, complicated by intestinal malrotation after successful antenatal treatment of hydrops fetalis

The authors report a female case of prune-belly syndrome having an antenatal sonographic diagnosis of hydrops fetalis and treated prenatally with transplacental digitalis administration. The findings of this case suggest that the clinical entity includes various phenotypes or aberrants having different origins.     

Prenatal sonographic diagnosis of posterior urethral valves: identification of valves and thickening of the posterior urethral wall

This report describes 2 heretofore unreported sonographic findings that may aid in the antenatal diagnosis of posterior urethral valves. Each of 2 fetuses showed a prominent or thickened posterior urethra and one or more bright echogenic lines representing valve tissue within a dilated and/or thickened posterior urethra. These findings helped solidify the antenatally suspected diagnosis of posterior urethral valves. The diagnosis was confirmed clinically and surgically during neonatal life. These 2 imaging findings may help in providing a more definitive antenatal diagnosis of posterior urethral valves and allow more expeditious therapy.     

Sonography of intestinal abnormality in the right iliac fossa

The findings on sonographic examination of intestinal disorders in the right iliac fossa are often nonspecific. We have found the classification system just described useful because it leads to a meaningful differential diagnosis, which may be narrowed on the basis of various distinguishing features. The use of other imaging techniques, imaging-guided aspiration or biopsy, or surgical intervention may be necessary to make the exact diagnosis.     

Morphological features of a case of retinoic acid embryopathy

A case of retinoic acid embryopathy which was retrospectively diagnosed after delivery is presented. The affected fetus was exposed to the drug during the first month of pregnancy and second-trimester sonographic examination showed hydrocephalus and cardiac malformation. The diagnosis was made on the basis of autopsy findings and genetic enquiry.     

Postoperative and post-traumatic acute cholecystitis. Value of ultrasound diagnosis

An often unrecognized but potentially fatal complication, mostly seen in posttraumatic patients under intensive care, is reactive acute cholecystitis. On account of the high specificity of ultrasound diagnosis in the biliary system we decided to examine the ultrasound criteria for early detection of posttraumatic cholecystitis. Ultrasound of the abdomen was performed prospectively, seven times on different days, in each of 40 artificially respirated patients under intensive care conditions over a period of 12 months. The results show that artificial respiration, parenteral feeding and previous trauma can lead to tardive (28/40) wall-thickening or to a three-layered wall of the gallbladder (9/40). In 22.5% of patients (9/40) we found the sonographic signs of acute cholecystitis. In correlation with the clinical signs, cholecystectomy was indicated in only two patients. The preoperative ultrasonographic findings and clinical signs of 23 patients with the diagnosis of acute reactive cholecystitis were analysed retrospectively. We found good correlation between sonographic and clinical signs of acute cholecystitis in 21 of these 23 patients. Our study shows that the morphological correlate of a thickened three-layered gallbladder wall can occur in the context of systemic alterations, even if there is no underlying cholecystitis. The diagnosis of acute reactive cholecystitis and the indication for cholecystectomy should be based on the synopsis of pathologic and clinical findings.     

Ultrasound evaluation of the fetal central nervous system

Evaluation of the fetal central nervous system is an integral part of any obstetric examination. Critical to the diagnosis of central nervous system abnormalities is a basic understanding of the normal fetal anatomy. Anatomic features of a normal ultrasound examination of the fetal central nervous system are discussed. In addition, the sonographic findings associated with a variety of major central nervous system anomalies are reviewed.