Ultrasonographic findings in the epididymis of pediatric patients with testicular torsion.

INTRODUCTION: Although grayscale ultrasound and color Doppler ultrasound characteristics of the torsed testis are well established in the literature, less is known about its anatomic partner: the epididymis. OBJECTIVE: The purpose of this study was to describe the ultrasound characteristics of the epididymis in pediatric patients with testicular torsion, and to describe their potential role as prognostic criteria for testicular salvage outcomes. STUDY DESIGN: During a retrospective review of 217 pediatric patients with acute testicular torsion during 2009-2016, morphological features of the epididymis from scrotal ultrasounds (size, parenchymal characteristics, and vascular flow of both epididymis heads), as well as patient demographics, time duration, surgical outcomes, histopathology results, and follow-up periods were analyzed. RESULTS: Mean epididymis size and twisting degree were significantly higher in the torsed testes than in the contralateral epididymis (P < 0.001) (Summary table). Cystic structures in the epididymis were identified: a higher number of cysts was associated with testicular non-viability (P = 0.025) and higher twisting degree (P = 0.017). Histopathologic examination showed that these spaces were infiltrated connective tissue most likely formed by venous congestion and vessel rupture. DISCUSSION: Scrotal ultrasound can provide information on testicular morphology and viability, as well as morphological changes in the epididymis over time in pediatric patients with testicular torsion. These findings may provide potential prognostic information regarding testicular viability, as a higher number of cystic spaces in the epididymis was associated with a higher rate of testicular non-viability and a higher twisting degree. In addition, the epididymis size (volume) can change during the time course of the ischemic state. CONCLUSIONS: This was the first study to describe and analyze epididymis ultrasound findings in pediatric patients with testicular torsion and to correlate them with testicular salvage outcomes. Further prospective studies are needed to determine the role of epididymis ultrasound findings as a potential pre-operative prognostic tool.

Novel clues for ultrasonographic diagnosis of reflux in pregnant women: a pilot study.

The aim of the present study was to define some novel radiological clues that may aid in the ultrasonographic diagnosis of gastroesophageal reflux in pregnant women. A total of 84 pregnant women, consisting of 42 reflux patients and 42 controls were included in the study. Reflux and control groups were compared in terms of age and our novel ultrasonographic landmarks related to oesophageal structure. While the two groups did not differ in terms of age, they were significantly different from each other with respect to: single layer, single wall oesophageal thickness; double layer, double wall oesophageal thickness; oesophageal hiatal diameter; perioesophageal fat pad thickness; hypoechogenic single wall muscularis mucosa and lamina propria thickness. Owing to our newly defined radiological clues, ultrasonography may have a 'greater than expected' role in the diagnosis of gastroesophageal reflux in pregnant women. However, further studies must be performed to document the actual diagnostic potential of these radiological tips.

Real time ultrasound guided pediatric percutaneous renal biopsy: the traditional method versus angled tangential approach.

AIM: The aim of the present study was to compare the success and complication rates of pediatric renal biopsy procedures between the angled tangential approach and the traditional approach. METHODS: From 2004 to 2009 we prospectively enrolled pediatric patients who had undergone real time ultrasound guided renal biopsy with angled tangential approach. For comparison, we retrospectively reviewed pediatric patients who had undergone traditional renal biopsy between 2002 and 2004. Adequacy of renal tissue histopathological samples and the complication rates were compared between groups. RESULTS: One hundred twenty-eight patients underwent traditional renal biopsy (Group A) while 166 patients underwent biopsy performed with angled tangential approach (Group B).The rate of inadequate material was higher in Group A compared to Group B (6.3% vs. 0.6%, p = 0.006). In four cases (three in Group A and one in Group B) renal biopsies revealed normal renal tissue. While a major complication (hemoperitoneum requiring transfusion) occurred in one case in Group A, no major complications were seen in Group B. CONCLUSION: Compared with the traditional technique, the angled tangential approach resulted in a higher adequate material rate and lower complication rate.These findings indicate that angled tangential approach could be considered for pediatric percutaneous renal biopsies.

Endovenous 1470 nm laser treatment of the saphenous vein: early report of pain assessment.

AIM: The aim of the paper was to evaluate the rate of postoperative pain by using endovenous laser ablation with wave-length of 1470 nm for incompetent saphenous veins in our single center experience. METHODS: A non-randomized prospective trial was performed. Patients with symptomatic varicose small saphenous vein and great saphenous vein were considered suitable for endovenous laser ablation. The VenaCure EVLT™ (Angiodynamics, Queensbury, NY) generator was used to provide laser energy (1470 nm emission wavelength). Pain was assessed on the 7th days, 1st months, 3rd months, and 6th months using a visual analog scale rating of 0 cm (no pain) to 10 cm (worst imaginable pain). RESULTS: Of the 30 patients who eventually underwent endovenous laser ablation, 14 underwent bilateral treatment. Totally, 44 treated legs were scored. When questioned by using a visual analog scale pain score of 0-10, patients, on average, graded their pain 3.86 ± 1.04 at admission, 2.83 ± 0.91 at 1 week, 1.46 ± 0.63 at 1 month, 0.63 ± 0.49 at 3 months, and 0.07 ± 0.25 at 6 months. No major complication occurred, and there was no deep venous thrombosis or pulmonary embolism nor skin ulceration. CONCLUSION: Endovenous laser ablation for chronic venous insufficiency with a 1470-nm diode laser appears to be effective and safe. The procedure is simple to perform, well accepted by patients and relatively atraumatic.

Virtual endoscope-assisted intracranial aneurysm surgery: evaluation of fifty-eight surgical cases.

OBJECTIVE: Better visualization of the intracranial aneurysm may improve surgical outcomes. To this aim, we evaluated the effectiveness of using virtual endoscopy (VE) during intracranial aneurysm surgery. METHODS: Fifty-eight patients with 63 intracranial aneurysms were enrolled in this study. Every patient was examined by digital subtraction angiography (DSA) and a randomly selected twenty-six cases were also examined by computed tomography (CT). CT angiography data were linked via imaging software for reconstruction of VE images. All patients were operated on using standard microsurgical procedures. Among these cases, randomly selected cohorts of twenty-six patients with 28 intracranial aneurysms were operated on also using VE-assisted surgical procedures. The surgical results of both groups were compared to determine the efficacy of the VE-assisted surgical procedure. RESULTS: Aneurysm locations, surgical timing and Hunt-Hess grade distribution were not statistically significant between both groups (p=0.948). However, significantly reduced complication rates and increased post-operative Glasgow outcome scores were observed in the VE group (p<0.05) compared to control. CONCLUSION: Aneurysms and surrounding anatomic structures were well depicted by VE in three dimensions with interactive fly-through views. This method improved our surgical results by improving visualization of the aneurysm and increasing surgical orientation. We report that this method can be very helpful to surgeons during intracranial aneurysm surgery and may reduce post-surgical complications.

Primary non-Hodgkin's lymphoma of the esophagus.

The esophagus is the least commonly involved gastrointestinal organ, accounting for fewer than 1% of patients with lymphoma. Such involvement is mostly secondary, from mediastinal lymph nodes or gastric lymphoma. The primary form arises from the esophageal wall itself and occurs much less frequently. Primary esophageal lymphoma is mostly seen in male patients with Hodgkin's disease. A primary non-Hodgkin's lymphoma of the esophagus with concomitant involvement of the bone marrow is presented, and imaging features of esophageal lymphoma are reviewed.