Contrast enhanced ultrasound in pediatric patients: a real challenge.

Ultrasound (US) imaging in the paediatric population has been a routine technique for decades, in part because of the advantages it offers over other imaging modalities. Off-label use (and its funding) is of the utmost importance in paediatrics because many drugs have not been evaluated in randomised trials in children. As a consequence such drugs are not specifically approved for use in children. This is also true for the contrast agents used in CEUS. The off-label use of CEUS in paediatric patients illustrates the need to deal with unresolved legal issues while at the same time balancing this with the need for high diagnostic performance in daily clinical routine. In addition to approved indications with a focus on the liver and Doppler enhancement, CEUS is safe and effective for the examination of many organs, as recently highlighted by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB). This article provides a summary of the available literature describing the utility of CEUS in paediatric patients. Furthermore, we suggest the establishment of a registry to collect data on safety and applications of ultrasound contrast agents in children. A paediatric registry has recently been introduced by EFSUMB (www.efsumb.org).

[Complications of internal tamponade with gas or silicone]. / Complicatiile tamponamentului intern cu gaz sau silicon.

This article presents the vitreous substitutes used in vitreoretinal surgery, emphasizing the complications of intraocular tamponade: refractive considerations, common toxicity of gases and silicone oil, specific toxicity of silicone oil, intraocular pressure abnormalities and lenticular complications.

Safety and Tolerability of SonoVue® in Patients with Large Artery Anterior Circulation Acute Stroke.

BACKGROUND AND PURPOSE: Ultrasound contrast agents (UCAs) are routinely used to improve the visualization of intracranial arteries. Since a higher rate of intracranial hemorrhage (ICH) has been observed in patients undergoing sonothrombolysis in combination with UCAs, we conducted this study with the aim of assessing safety and tolerability of SonoVue® in patients with acute ischemic stroke due to anterior circulation large artery occlusion (LAO) and eligible to intravenous thrombolysis and/or mechanical thrombectomy. METHODS: Among 474 patients consecutively admitted to our Stroke Unit with anterior circulation ischemic stroke, SonoVue® was administered during transcranial ultrasound evaluation to 48 patients with suspected LAO for diagnostic confirmation (group I) and to 44 patients with inadequate temporal bone window. Forty-eight stroke patients with LAO diagnosed only by computed tomography (CT) angiography /magnetic resonance (MR) angiography and matched for age, gender, and National Institutes of Health Stroke Scale score with group I represented the control group (group II). Thrombolysis, thrombectomy, or combined treatment were offered to all eligible patients. Brain MR imaging/CT was performed in both groups in case of neurological deterioration or after 1 week to check for ICH. RESULTS: SonoVue® did not cause any serious adverse event; only mild and transient side effects were reported in six cases (6.5%). Among patients in groups I and II, there were 31 (32.3%) secondary cerebral bleedings with no statistically significant difference between the groups, but only 2 (2.1%) were symptomatic. CONCLUSIONS: According to our study, SonoVue® can be safely administered to acute ischemic stroke patients with suspected anterior circulation LAO and/or inadequate temporal bone window.

[Superior bullous retinal detachment: value of the intravitreous injection of sulfur hexafluoride]. / Décollement de rétine bulleux supérieur: intérêt de l'injection intravitréenne d'hexafluorure de soufre.

15 cases of superior bullous hemi-retinal detachment were repaired during a 16-month period, with a post-operative follow-up of 3-19 months. Intravitreal injection of 0,75-1,5 cc of pure sulfur hexafluoride (SF 6) was performed in 9 cases. The indications for injection at the end of the procedure were: 1) absence of chorioretinal contact in spite of an indentation in the correct position; 2) fishmouth configuration of the retinal break; 3) presence of radial folds over an indentation parallel to the limbus. Only two out of patients required a second operation, due to the development of proliferative vitreoretinopathy. One case was unsuccessful because of a redetachment secondary to massive periretinal proliferation. No complication was observed with the injection of SF 6. In particular, ocular hypertension was avoided by controlling the amount of gas used, always inferior to 2 cc, and postoperative treatment with acetazolamide and topical timolol. The intraocular injection of SF 6 appears to be useful contribution to the surgical treatment of superior bullous hemi-retinal detachment, allowing effective and durable internal tamponade, while avoiding prolonged bedrest.