Status of the thyroid gland in pregnancy and its relation to postpartum depression

OBJECTIVES: Adequate adjustments by the hypothalamic-pituitary-thyroid axis during pregnancy allow women to remain euthyroid with only slight changes in thyroid volume and other thyroid functions. In approximately 10 percent of women, the challenge of thyroid economy results in sub-clinical hypothyroidism. This study is to elucidate the association between such hypothyroidism and postpartum depression, if any. METHOD: Blood samples were collected from 73 healthy subjects attending the antenatal clinc of the University Hospital of the West Indies, at booking, 28 weeks, 36 weeks of gestation, and 1 day and 6 weeks postpartum. Serum level of total thyroxine, free tri-iodothyronine, and thyroid stimulating hormone (TSH) were determined by radioimmunoassays. The thyroid volume was estimated by ultrasonography in some subjects. A self-rating depression scale was administered at 28 weeks of gestation and at 6 weeks postpartum for quantitative measurement of depression. The preliminary results revealed that 22 subjects (30 percent) had postpartum depression, 12 (16 percent) had mild depressin and 10 (14 percent) had moderated to marked depression. Of these, only 2 subjects had total thyroxine values less than 5.5g/100 ml and TSH values greater than 2.5 IU/ml. There were no significant changes between postpartum and antepartum thyroid volumes. CONCLUSION: Although a significant number of women in this study had postpartum depression, no significant relationship between depression and the serum levels of thyroid hormones was established.(Au)

Solid and Papillary epithelial neoplasm. Ultrasound and CT features of an unusual pancreatic tumour

The ultrasonographic and computed tomography features of four cases of solid and papillary epithelial neoplasm (SPEN) - a rare pancreatic tumour - are described. Although not diagnostic, the presence of these imaging features in the typical clinical setting may permit pre-operative radiological diagnosis and facilitate planning for curative surgery for this malignant tumour which has an excellent prognosis even without further adjuvant therapy.(Au)

Ultrasound biomicroscopy in uveitis

Ultrasound Biomicroscopy (UBM) is an imaging technique using ultrasound waves to produce a two-dimensional real time view of the anterior segment of the eye up to a depth of five millimeters. The cross section images are obtained using a high frequency ultrasound (50 to 100 MHz) transducer, incorporated into a B-mode clinical scanner. Axial and lateral resolutions of the anterior segment structures are within 20 to 60 mm. This is ten times the resolution achieved by the conventional ophthalmic ultrasound imaging frequencies. As a relation exists between image resolution and waves, tissue penetration ultrasound biomicroscopy has a penetration depth of only five millimeters, but can be increased to 15 mm using an orbital cup filled with methylcellulose that allows a shorter work transducer distance. Commerically available scanners produce a 5 X 5-mm transducer field with 256 image lines at a scan rate of 8 frames per second. This system generates images of the anterior segment of the eye, the pars plana and peripheral retina. Clincial applications of UBM have been previously described, including imaging in cases of glaucoma, anterior segment and peripheral choroidal tumours, ocular trauma, corneoscleral phakic and pseudophakic pathologies. With UBM, the anterior segment of the eye can be better observed in cases of corneal opacities, cataract, hyphaema and intraocular anterior membranes. UBM also provides information that cannot be obtained with the clinical examination alone. This talk highlights some of the findings of ultrasound biomicroscopy in anterior uveitis. UBM provides a view of the inferior angle in cases of hypopyon. Sometimes what looks like a hypopyon can be a cyst filled with inflammatory cells. A sign of granulomatous inflammation that can be observed with UBM is a localized thickening of the interior peripheral cornea at the six o'clock position (prismatic effect). Many cases that present this prismatic effect will be associated with sarcoidosis. Inflammation of the ciliary body and the vitreous base can be observed in ways that are not possible with the direct ophthalmoscope and the tree mirror contact lens. Circumscribed areas of reflectivity and thickness changes in UBM images resembing nodules are often seen in the ciliary bodies in cases of sarcoidosis or in severe chronic granulomatous uveitis.(AU)

Normal kidney dimensions in healthy Jamaicans: a sonographic study - Poster presentation

A sonographic study of 49 randomly selected healthy adult Jamaicans was conducted to establish a guide for renal dimensions in the population. The mean length of the right kidney was 9.7+/-0.7 cm and the left 10+/-0.7cm. The left kidney was longer than the right in the overall group and in males. There was no difference in width between left or right kidneys in the group as a whole or within either sex. There was a significant association between the weight of males and width of their kidneys; however, this association was not seen in females. The lone association between weight of participants and renal length occurred in females and only with respect to the left kidney. Lengths and widths of kidneys were not associated with height in either gender. Renal surface area (RSA) was similar between the sexes and also between right and left kidneys. Similarly, there was no significant association between renal length and body surface area (BSA) overall or within the sexes. The ratio of renal surface area to body surface area (BSA) which gives an indication of renal mass was positively correlated in males but not in females (AU)

Evaluation of transabdominal ultrasonography for ectopic pregnancy

Ultrasound examination was performed on 66 patients with suspected ectopic pregnancy. Of 23 women who had the diagnosis confirmed at laparotomy, 16 (69.6 percent) were correctly identified on ultrasound, 4 were reported as unliklely ectopic pregnancies and 3 were undetermined. Two patients with false negative ultrasound reports had positive findings on the ultrasound, but the findings were misinterpreted. Correct identification of these would have increased the true positive rate to 78.3 percent and decreased the false negative rate to 8.8 percent. There were 5 false positive reports due to overian cysts (AU)

Accurate pre-operative diagnosis of ovarian cancer by a combination of clinical criteria, ultrasonography and CA 125 - abstract

Early pre-operative treatment of ovarian cancer is hindered by a lack of reliable criteria for its early diagnosis. This study was undertaken to assess the value of clinical criteria, ultrasonography and serum CA 125 values in the differential diagnosis of benign and malignant pelvic masses. Thirty-six consecutive patients who had elective surgery for investigation and management of an adnexal mass were enrolled in the study from May to October, 1988. All patients had a clinical examination, serum CA 125 measurement and ultrasound pre-operatively, and their menopausal status determined. Based on these findings, a scoring system was devised (Table). Twenty patients had serum CA 125 values < 35 U/ml and histology confirmed a benign ovarian lesion. The remaining 16 patients had serum CA 125 levels > 35 U/ml, and their tumours were confirmed to be malignant histologically. There were significant differences in age (p<0.01), menopausal status (p=0.01), clinical impression score (p<0.01), ultrasound score (p<0.001) and serum CA 125 level (p<0.001) in patients with benign as compared to malignant lesions. The most useful single diagnostic criterion was serum CA 125 levels, and diagnostic accuracy was increased by adding menopausal status and ultrasound findings (sensitivity > 90 per cent; specificty 95.2 per cent) (AU)

The relationship between red cell glutathione and hepatic steatosis in malnourished Jamaican children - abstract

Low levels of red cell glutathione (a scavenger of free radicals) have been previously shown to correlate well with the presence of oedema in malnourished children. We addressed the possibility that they may also correlate with the extent of hepatic steatosis. Thirty-three children were studied on three occasions - on admission, in early weight gain and at discharge. Ultrasonography was used to assess hepatic fat. The oedematous children had significantly more hepatic fat on admission than the non-oedmatous (p<0.01), but no child had a normal ultrasound. We found a significant inverse relationship (r = -0.53, p<0.001) between hepatic fat and the level of red cell glutathione that disappeared over time. We conclude that, firstly, hepatic steatosis occurs commmonly in even non-oedematous malnourished children. Secondly, this is associated with low levels of glutathione which may have aetiological implications (AU)

Abdominal air: the radiologist's enemy and friend

Two cases are presented which illustrate the radiological drawbacks and advantages of air when it is present either around or within an organ of clinical interest. The physical principles underlying this anomaly are briefly discussed, particularly in relation to plain film radiology and ultrasonic imaging. The importance of recognising this phenomenon and the diagnostic difficulties which may arise are stressed (AU)

Ultrasonic demonstration of portal vein occlusion

The ultrasonic detection of pre-sinusoidal portal vein obstruction is described in a patient with clinical features of alcoholic liver disease. The case illustrates the advantages of ultrasound in the evaluation of the portal circulation, including some unusual radiological observations of the portal circulation (AU)

Omental cyst masquerading as ascites

This report describes a three-year-old girl with an omental cyst masquerading as ascites. A review of the literature has shown that large omental cysts are frequently misdiagnosed as ascites. Ultrasonography is a valuable aid in the diagnosis (AU)

Splenic metastases in ovarian carcinoma

We report two cases of ovarian carcinoma with splenic metastases detected by ultrasound and discuss their sonographic appearances. The importance of routinely including this organ during staging and follow-up studies in ovarian carcinoma using diagnostic imaging methods is emphasized (AU)

Ultrasonography in the diagnosis and management of biliary ascariasis

Biliary ascariasis has traditionally been a poorly recognised clinical entity. Because of unsatisfactory diagnostic tests, most diagnoses are made accidentally by surgeons at laparotomies for evaluation of right upper quadrant pain, often misdiagnosed as cholecystitis. Consequently this has been regarded as a "Surgical" condition. Diagnostic ultrasonography offers a reliable method for evaluating the biliary tree. At ultrasonography, Ascaris lumbricoides can be indentified in the biliary tree and medical management pursued. Follow-up ultrasound studies enable the process of resolution to be monitored and possible complications to be identified. This is the first report on the use of diagnostic ultrasonography in the diagnosis and management of biliary ascariasis in the English-speaking Caribbean, and illustrates the characteristic diagnostic features of the condition. A new sign of biliary ascariasis, 'the can of sausages sign', is also described (AU)

Ultrasonography in jaundice - abstract

The evaluation of the patient with suspected obstructive jaundice has traditionally been perplexing. Liver biopsy and percutaneous transhepatic cholangiography are invasive and not widely available. Many patients have therefore not benefited from pre-operative diagnosis. Between August 1981 and December 31st, 1982, 127 such patients were referred for ultrasound examination. In 74 cases biliary obstruction was demonstrated and in 73 the level of the obstruction was identified. The cause of obstruction was identified in 64 of these. Inoperability was predicted in 19. In 16 cases, a non-obstructing lesion associated with jaundice was seen and in 37 the sonogram was normal. The need for liver biopsy was reduced to 37 cases and for percutaneous cholangiogram to 10. In this service hepatobiliary ultrasonography now stands as the investigation of choice in suspected obstuctive jaundice (AU)