Scrotal calculi in clinical practice and their role in scrotal pain: A prospective study.

PURPOSE: Scrotal calculi are rare, and their clinical significance is uncertain. Scrotal pain is a frequent, hard-to-manage problem in urology clinics. Our purpose in this study was to determine the relationship between the presence of scrotal calculi and scrotal pain in a prospective manner. METHODS: Sonography and color Doppler ultrasound of the scrotum were performed in 758 consecutive patients referred with scrotal pain. The pain was rated by using an 11-point numeric rating scale; scores were compared among patients with scrotal calculi with and without additional scrotal pathology. RESULTS: Scrotal calculi were detected in 73 of the 758 patients (9.6%). Scrotal pain (n = 50 [61%]) and a palpable mass in the scrotum (n = 25 [30.5%]) were the most common complaints in patients with scrotal calculi. Hydrocele (n = 17 [29.8%]) and varicocele (n = 15 [26.3%]) were the most commonly associated abnormalities; there was a statistically significant association between the presence of scrotal calculi and hydrocele (p < 0.01). Scrotal pain was present in 61 (83.5%) patients with scrotal calculi, and this association was significant (p < 0.001). The presence of scrotal pain and the correlation between location of calculi and pain in patients without additional scrotal abnormalities were also significant (p = 0.04 and p < 0.004, respectively). CONCLUSIONS: The prevalence of scrotal calculi was 9.6%, and hydrocele was found to be associated with scrotal calculi. We also found a significant relationship between the presence of calculi and scrotal pain. Because the etiology of scrotal pain is essential for appropriate treatment, scrotal calculi should be kept in mind when making a differential diagnosis of scrotal pain. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43:406-411, 2015.

Real-time sonoelastography of Achilles tendon in patients with ankylosing spondylitis.

OBJECTIVE: Real-time sonoelastography (SE) is a new ultrasound-based imaging technique that provides information on tissue elasticity and stiffness. We determined the efficacy of SE for assessing Achilles tendon abnormalities in patients with ankylosing spondylitis (AS). MATERIALS AND METHODS: Forty-one consecutive AS patients and 32 asymptomatic healthy subjects were enrolled. Achillodynia was scored on a 0- to 100-mm visual analog scale. A high-resolution ultrasound machine equipped with an elastography-compatible linear probe was used to perform bilateral B-mode ultrasound, Doppler ultrasound, and SE examinations of Achilles tendons. Tendons were divided into proximal, middle, and distal segments. B-mode examinations included tendon thicknesses, echotextures, and enthesopathic findings. SE using color-coded images was performed in the same areas. Normal consistent tendon structures were coded as blue or green, and moderately (yellow) or severely (red) softened areas were considered pathological. RESULTS: The distal third of the Achilles tendons was the most commonly affected part in the AS patients compared with healthy subjects (p = 0.001), whose middle third was more commonly affected. Achillodynia intensity tended to be higher in patients with pathological B-mode or SE examination findings (p = 0.09 and p = 0.07 respectively). Softening detected by SE in the distal third was associated with enthesopathy findings such as calcaneal bone erosions (Fisher's X (2), p = 0.07) and tendinous enlargement (Fisher's X (2), p = 0.001). B-mode and SE findings had moderate to good correlation in the assessment of Achilles tendon abnormalities. CONCLUSIONS: Sonoelastography may be useful for the evaluation of tendon abnormalities in patients with AS; in addition; it may be useful for the evaluation of other inflammatory rheumatic conditions.

Irregular yolk sac shape: is it really associated with an increased risk of spontaneous abortion?

OBJECTIVES: The yolk sac is the first conceptional structure that becomes sonographically visible within the gestational sac. Because the yolk sac is the primary route of exchange between the embryo and the mother, it is essential in early embryonic life. This study aimed to determine whether an irregular yolk sac shape is associated with an increased risk of spontaneous abortion. METHODS: The shape and size of the yolk sac were assessed by transvaginal sonography in 183 women who had normal and healthy pregnancies with gestational ages of 6 to 8 weeks. RESULTS: Most of the embryos had a yolk sac with a regular shape (152 of 183 [83%]), whereas the remaining embryos had a yolk sac with an irregular shape (31 of 183 [17%]). Although there was a trend toward a lower rate of irregular yolk sacs with advancing gestational age, the difference was not statistically significant (P = .13). Spontaneous abortion occurred in 6 of 183 pregnancies (3.3%): 1 of the 31 (3.2%) with an irregular yolk sac shape and 5 of the 152 (3.3%) with a regular yolk sac shape. The rates of spontaneous abortion were statistically similar for pregnancies with a regular yolk sac shape and those with an irregular shape (P > .99). CONCLUSIONS: This study suggests that an irregular yolk sac shape is unrelated to an increased risk of spontaneous abortion.

Use of the Amplatzer Type 2 Plug for Flow Redirection in Failing Autogenous Hemodialysis Fistulae.

PURPOSE: To present our experience with redirecting the outflow of mature arteriovenous fistulae (AVFs) in patients with cannulation and/or suboptimal flow problems by percutaneous intervention using the Amplatzer Vascular Plug II (AVP II). METHODS: We retrospectively reviewed patients who presented with difficulty in cannulation and/or suboptimal flow in the puncture zone of the AVF and who underwent intervention using the AVP II to redirect the outflow through a better cannulation zone from March 2009 to November 2012. The mean survival rate of all AVFs was estimated, and the effects of patient age, sex, and AVF age on the AVF survival time were determined. RESULTS: In total, 31 patients (17 male and 14 female) with a mean age of 57.8 years (range, 20-79 years) were included. In 2 patients, the AVF failed within the first 15 days because of rapid thrombosis. In 9 patients, the new AVF route was working effectively until unsalvageable thrombosis developed. One of the 31 patients died 9 months before the last radiologic evaluation. The new AVF route was still being used for dialysis in the remaining 19 patients. The mean AVF survival rate was 1,061.4 ± 139.4 days (range, 788-1,334 days). Patient age, sex, and AVF age did not affect the survival time. CONCLUSION: We suggest that the AVP II is useful for redirecting the outflow of AVFs with cannulation problems and suboptimal flow. Patency of existing AVFs may be extended, thereby extending surgery-free or catheter intervention-free survival period.

Sonoelastographic assessment of the age-related changes of the Achilles tendon.

AIMS: Tendons are crucial for optimal muscle force transfer and subject to changes with aging which may impair functional ability of elderly individuals. Achilles is the largest and the strongest tendon in the body; therefore it is an excellent site for the radiologic investigation of aging of tendons. Sonoelastography (SE) is a new ultrasound-based imaging technique that provides information on elastic properties and stiffness of tissues. The aim of our study was to investigate the age-related alterations in Achilles tendons using SE. MATERIAL AND METHODS: Forty five geriatric (age ≥ 65 years) and 42 young (age 18-40 years) healthy consecutive subjects were enrolled. Subjects with known history of metabolic or endocrine diseases, sports or traumatic injuries, peripheral vascular disorders were excluded. Both Achilles tendons were scanned with a real-time SE probe at a frequency of 6-15 MHz. Strains of Achilles tendons' proximal, middle and distal parts were assessed semi-quantitatively with comparing a reference tissue. RESULTS: Both SE methods -color coded evaluation and strain measurement- showed a remarkably stiffer tendon in the elderly subjects compared to young subjects in all thirds of Achilles tendons. In young subjects 84.9 % tendon thirds were blue, and 15.1% were green whereas, in elders 93.7% were blue and 6.3% were green (p=0.024). There was a significant correlation between age and stiffness of tendons assessed with strain indices. CONCLUSION: Our result showed increased tendon stiffness in elderly subjects which might be responsible for the high prevalence of Achilles tendinopathies observed in elderly subjects.

Real time sonoelastographic evaluation of renal allografts in correlation with clinical prognostic parameters: comparison of linear and convex transducers according to segmental anatomy.

BACKGROUND: Renal transplantation is the treatment of choice in end-stage renal disease. Chronic allograft dysfunction is the leading cause of chronic allograft failure. Surveillance biopsy is the only reliable tool to detect early fibrosis in the allograft. There is a need for non-invasive methods for the detection of early development of renal allograft fibrosis. AIMS: To analyze the reliability of sonographic elasticity index and resistive index measurements in the evaluation of renal transplant fibrosis using linear and convex transducers according to segmental anatomy. MATERIALS AND METHODS: Elasticity index and resistive index were measured in 28 renal transplants and correlated with clinical prognostic parameters. Donor age above 50 years old, post transplantation time over 60 months and serum creatinine level above 1.5 mg/dl were defined as poor prognostic parameters. RESULTS: Renal transplant recipients with serum creatinine level above 1.5 mg/dl demonstrated higher mean elasticity index (p=0.006) with a convex probe and higher elasticity index in the middle segments both with a convex and a matrix linear probe (p=0.026, p=0.001). Renal transplant recipients with post-transplantation time of 60 months and more demonstrated higher resistive index values in the middle segments (p=0.016). CONCLUSIONS: Convex probe was able to detect the changes in mean stiffness better than the matrix linear probe. The measurements from subsegments might suggest that diffuse changes in stiffness can truly be detected in the middle segments or that fibrotic processes start from the middle segments of the renal transplants. Further studies correlated with histopathology are required to validate the findings.

The use of real-time elastography in the assessment of gallbladder polyps: preliminary observations.

AIMS: Gallbladder polyps often have a benign nature. Current guidelines suggest surgical removal of polyps greater than 10 mm. However, the accuracy of the size criteria is limited because neoplasia can be found in gallbladder polyps less than 10 mm. The aim of this study was to evaluate the feasibility of real time elastography for gallbladder polyps and to demonstrate the elasticity properties of the polyps. MATERIAL AND METHOD: Fifty-three polypoid lesions of the gallbladder were prospectively examined with real-time elastography. Of these patients, 52 had a diagnosis of benign gallbladder polyps and one patient was accepted as a gallbladder carcinoma due to its clinical and radiological findings. B-mode and real-time elastographic images were simultaneously presented as a two-panel image, and the elastogram was displayed in a color scale that ranged from red (greatest strain, softest component), to green (average strain, intermediate component), to blue (no strain, hardest component). RESULTS: The mean size for benign gallbladder polyps was 7.2 +/- 3 mm (range, 5-21 mm). All benign gallbladder polyps on consecutive real-time elastographic images appeared as having a high-strain elastographic pattern. Only one patient who was accepted with gallbladder carcinoma had a gallbladder polyp with low elasticity properties. CONCLUSIONS: Our study showed that real time elastography of gallbladder polyps is feasible. This novel approach may be useful for the characterization of polypoid lesions of the gallbladder.